Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 174470-1 | NY |
N | 2080P0201X | Pediatric Allergist | 174470 | NY |
Y | 2080P0201X | Pediatric Allergist | ME112011 | FL |
NPI | 1184660821 |
---|---|
Provider Name | Mark Ballow |
First Address | Orlando, FL 32891-0001 |
Second Address | Tampa, FL 33606-3603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 27/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00010009301 | UNIVERA (01) | |
000510824001 | BC/BS (01) | |
0011295550001 | (05) | PA |
008130000 | (05) | FL |
01084606 | (05) | NY |
0207420 | IHA (01) | |
040426000993 | FIDELIS (01) | |
14P6J | BLUE CROSS BLUE SHIELD (01) | FL |
C64942 | (02) | NY |