1649375569 NPI number — DONNA W BALLARD MD

Table of content: DONNA W BALLARD MD (NPI 1649375569)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649375569 NPI number — DONNA W BALLARD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALLARD
Provider First Name:
DONNA
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649375569
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2847
Provider Second Line Business Mailing Address:
DEPT 1060
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36652-2847
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-809-3530
Provider Business Mailing Address Fax Number:
562-924-5860

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3719 DAUPHIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36608-1753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-460-5333
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  12355 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 51084059 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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