Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 008631 | LA |
Y | 111NI0900X | Internist | 008631 | LA |
NPI | 1003176868 |
---|---|
Provider Name | Mr. John Edward Ball SR. |
First Address | Mandeville, LA 70448 |
Second Address | Mandeville, LA 70448 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2012 |
Last Update Date | 25/05/2012 |