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General NPI Number Information
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NPI Number | 1346416542
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Entity Type | Organization
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Legal Business Name | WF BALLESTEROS MD
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Dates
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Enumeration Date | 05/07/2008
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Last Update Date | 05/07/2008
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Provider Practice Location Address
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Address Line | 3901 FAIRWOOD CT
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City | MIDLAND
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State | TX
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Zip | 79707-1428
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Country | US
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Telephone | 432-697-1562
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Fax | 432-699-3801
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Provider Business Mailing Address
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Address Line | 3901 FAIRWOOD CT
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City | MIDLAND
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State | TX
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Zip | 79707-1428
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Country | US
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Telephone | 432-697-1562
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Fax | 432-699-3801
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Authorized Official
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Title or Position | OWNER
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Name | WELLINGTON F BALLESTEROS
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Credential | MD
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Telephone | 432-697-1562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | H6770
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License Number State | TX
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