Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 9662062-1205 | UT |
NPI | 1730381625 |
---|---|
Provider Name | Dr. Douglas James Ball |
First Address | Salt Lake City, UT 84148 |
Second Address | Salt Lake City, UT 84148 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2007 |
Last Update Date | 11/06/2018 |