Provider Demographics
NPI:1215960109
Name:BALARBAR, MELINDA BAUTISTA (MD)
Entity type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:BAUTISTA
Last Name:BALARBAR
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 1:1110 PARKER SQ
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-7432
Mailing Address - Country:US
Mailing Address - Phone:972-724-1707
Mailing Address - Fax:972-724-1407
Practice Address - Street 1:1110 PARKER SQ
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-7432
Practice Address - Country:US
Practice Address - Phone:972-724-1707
Practice Address - Fax:972-724-1407
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9485207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX037072802Medicaid
TX87941YOtherBCBS
TX080166712OtherRR MEDICARE
H29281Medicare UPIN
TX037072802Medicaid