Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 2836 | AL |
NPI | 1023086949 |
---|---|
Provider Name | Dr. John B Ballard |
First Address | Birmingham, AL 35255-5310 |
Second Address | Birmingham, AL 35249-1900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T68645 | (02) | AL |