Provider Demographics
NPI:1104818160
Name:BALA, SAM G (MD)
Entity type:Individual
Prefix:DR
First Name:SAM
Middle Name:G
Last Name:BALA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:37840 MEDICAL ARTS CT
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33541-4325
Mailing Address - Country:US
Mailing Address - Phone:813-788-5569
Mailing Address - Fax:813-788-5569
Practice Address - Street 1:37840 MEDICAL ARTS CT
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541-4325
Practice Address - Country:US
Practice Address - Phone:813-788-5569
Practice Address - Fax:813-788-5569
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2008-01-31
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Provider Licenses
StateLicense IDTaxonomies
FLME36543208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL081262OtherAVMED
FL0624114OtherAETNA HEALTHCARE
FL51137OtherBLUE CROSS BLUE SHIELD FL
FL10751OtherWELLCARE
1700023OtherUNITED HEALTHCARE
FL203008OtherAMERIGROUP
FL0624114OtherAETNA HEALTHCARE
1700023OtherUNITED HEALTHCARE