Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | PA.0006891 | CO |
N | 2081S0010X | Sports Medicine | PA.0006891 | CO |
N | 213ES0000X | Sports Medicine | PA.0006891 | CO |
NPI | 1326690678 |
---|---|
Provider Name | Joseph Ballent |
First Address | Boulder, CO 80303-4284 |
Second Address | Boulder, CO 80303-4284 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2019 |
Last Update Date | 05/11/2021 |