Provider Demographics
NPI:1730148693
Name:BALCELLS, SHARON P (MD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:P
Last Name:BALCELLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 S GENERAL BRUCE DR
Mailing Address - Street 2:STE 75
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-1469
Mailing Address - Country:US
Mailing Address - Phone:254-743-1628
Mailing Address - Fax:
Practice Address - Street 1:4501 S GENERAL BRUCE DR
Practice Address - Street 2:STE 75
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1469
Practice Address - Country:US
Practice Address - Phone:254-743-1628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6809207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110211238OtherRR/MEDICARE
TX0465064-01Medicaid
TX88391KOtherBLUE SHIELD
TX88391KMedicare ID - Type Unspecified
TX0465064-01Medicaid