Basic Information
| Provider Information | |||||||||
| NPI: | 1861589996 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KEATES-BALEEIRO | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 910 BLACKFORD ST | ||||||||
| Address2: | 5TH FLOOR MASSOUD BUILDING, PEDIATRIC ONCOLOGY | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374031405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237787289 | ||||||||
| FaxNumber: | 4237786848 | ||||||||
| Practice Location | |||||||||
| Address1: | 910 BLACKFORD ST | ||||||||
| Address2: | 5TH FLOOR MASSOUD PEDIATRIC ONCOLOGY | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374031405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237787289 | ||||||||
| FaxNumber: | 4237786848 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2006 | ||||||||
| LastUpdateDate: | 06/06/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0207X | MD39941 | TN | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology |
No ID Information.