Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 3822 | AL |
NPI | 1144300658 |
---|---|
Provider Name | Dr. James Fletcher Ballard |
First Address | Vestavia Hills, AL 35217 |
Second Address | Vestavia Hills, AL 35216-1258 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 08/07/2007 |