Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 35.024246 | OH |
NPI | 1295758530 |
---|---|
Provider Name | Theodore Raymond Ball |
First Address | Bellevue, OH 44811-9015 |
Second Address | Bellevue, OH 44811-9015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 27/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0411503 | (05) | OH |
A70506 | (02) | OH |