Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 205801 | LA |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | M6514 | TX |
NPI | 1043306392 |
---|---|
Provider Name | Charles Joseph Ballay II |
First Address | Marrero, LA 70072-3148 |
Second Address | Marrero, LA 70072-3148 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 10/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2351753 | (05) | LA |