Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 28459 | NE |
Y | 2084N0402X | Child Neurologist | 28459 | NE |
NPI | 1164867552 |
---|---|
Provider Name | Austin Robert Baltensperger |
First Address | Jbsa Fort Sam Houston, TX 78234-4504 |
Second Address | Jbsa Fort Sam Houston, TX 78234-4504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2013 |
Last Update Date | 16/01/2020 |