Individual
DR. JASON JASPER BALLEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1400 E DOWNING ST, TAHLEQUAH, OK 74464-3324
(918) 456-0641
Mailing address
3829 S MADISON AVE, TULSA, OK 74105-3062
(918) 316-4330
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
25130
OK
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
Primary
25130
OK
Other
Enumeration date
08/02/2006
Last updated
06/23/2021
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