Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD423750 | PA |
Y | 2080P0202X | Pediatric Cardiologist | 45686 | TN |
N | 2080P0202X | Pediatric Cardiologist | MD423750 | PA |
N | 2080P0203X | Pediatric Critical Care Doctor | MD423750 | PA |
NPI | 1043236730 |
---|---|
Provider Name | Jean A Ballweg |
First Address | Memphis, TN 38103-2816 |
Second Address | Memphis, TN 38103-2816 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 25/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0068667 | (05) | NJ |
101246287 | (05) | PA |
I28657 | (02) | PA |