MEDICARE: DR. CHRISTOPHER J BALLARD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	ME109317	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00977190	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14FN0	OTHER	FL	BCBS OF FLORIDA
2	349086	OTHER	FL	AVMED
4	7724400	OTHER	FL	CIGNA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	1086695	OTHER	FL	CAREPLUS
7	9836728	OTHER	FL	AETNA
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164679668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER J BALLARD MD

Provider Business Mailing Address
First Line	:	4651 VAN DYKE RD
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33558-4880
Country	:	US
Telephone Number	:	813-321-1786
Fax Number	:	813-321-1786

Provider Business Practice Location Address
First Line	:	11200 SEMINOLE BLVD STE 205
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33778-3240
Country	:	US
Telephone Number	:	813-321-1786
Fax Number	:	813-321-1787

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2008
Last Update Date	:	01/15/2019

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Directions to “ DR. CHRISTOPHER J BALLARD MD” Practice Location

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