MEDICARE: JAIME A BALDERRAMA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	17010	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457344715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAIME A BALDERRAMA MD

Provider Business Mailing Address
First Line	:	4524 N MARYVALE PKWY
Second Line	:	SUITE 110
City	:	PHOENIX
State	:	AZ
Zip	:	85031-1730
Country	:	US
Telephone Number	:	623-845-9009
Fax Number	:	623-845-6933

Provider Business Practice Location Address
First Line	:	4524 N MARYVALE PKWY
Second Line	:	SUITE 110
City	:	PHOENIX
State	:	AZ
Zip	:	85031-1730
Country	:	US
Telephone Number	:	623-845-9009
Fax Number	:	623-845-6933

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	07/08/2007

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Directions to “ JAIME A BALDERRAMA MD” Practice Location

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