Healthcare Provider Details

I. General information

NPI: 1871592477
Provider Name (Legal Business Name): EDWARD B BALLOW DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 06/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 S TAMARAC DR SUITE 300
DENVER CO
80237-1419
US

IV. Provider business mailing address

3525 S TAMARAC DR SUITE 300
DENVER CO
80237-1419
US

V. Phone/Fax

Practice location:
  • Phone: 303-758-9031
  • Fax: 303-758-7643
Mailing address:
  • Phone: 303-758-9031
  • Fax: 303-758-7643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number337
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: