Basic Information
| Provider Information | |||||||||
| NPI: | 1821355868 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALDERAMOS | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | JOE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 907 EUREKA ST STE B | ||||||||
| Address2: | |||||||||
| City: | WEATHERFORD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760865880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8175988150 | ||||||||
| FaxNumber: | 8175994902 | ||||||||
| Practice Location | |||||||||
| Address1: | 907 EUREKA ST STE B | ||||||||
| Address2: | |||||||||
| City: | WEATHERFORD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760865880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8175988150 | ||||||||
| FaxNumber: | 8175994902 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2012 | ||||||||
| LastUpdateDate: | 05/28/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | R3999 | TX | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.