Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0129X | Vascular Surgeon | 289654-1205 | UT |
Y | 2086S0129X | Vascular Surgeon | MD197064 | OR |
NPI | 1134324528 |
---|---|
Provider Name | James Robert Ballard |
First Address | Bend, OR 97701-7760 |
Second Address | Bend, OR 97701-7760 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2007 |
Last Update Date | 29/10/2021 |