Basic Information
| Provider Information | |||||||||
| NPI: | 1881672285 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BHALOO | ||||||||
| FirstName: | SALIM | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 961205 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761611205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177408400 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4425 E US HIGHWAY 377 STE 104 | ||||||||
| Address2: | |||||||||
| City: | GRANBURY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760497475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6829364081 | ||||||||
| FaxNumber: | 8175700704 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2006 | ||||||||
| LastUpdateDate: | 11/03/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | L1270 | TX | Y | Allopathic & Osteopathic Physicians | Otolaryngology | 207YX0602X | L1270 | TX | N | Allopathic & Osteopathic Physicians | Otolaryngology | Otolaryngic Allergy | 207YS0123X | L1270 | TX | N | Allopathic & Osteopathic Physicians | Otolaryngology | Facial Plastic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 171536901 | 05 | TX | MEDICAID | 8F0718 | 01 | TX | BCBS | OTHER |