Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | M-9620 | ID |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | M-9620 | ID |
NPI | 1124131818 |
---|---|
Provider Name | Dr. Bruce Ryan Ball |
First Address | Meridian, ID 83642 |
Second Address | Boise, ID 83704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 23/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
407610101 | (05) | TX |