Healthcare Provider Details

I. General information

NPI: 1740779065
Provider Name (Legal Business Name): WILLIAM KOLBY BALL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 LASALLE LEFFALL DR
QUINCY FL
32351-5278
US

IV. Provider business mailing address

178 LASALLE LEFFALL DR
QUINCY FL
32351-5278
US

V. Phone/Fax

Practice location:
  • Phone: 850-875-3600
  • Fax:
Mailing address:
  • Phone: 850-875-3600
  • Fax: 850-627-7277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0667
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number6607
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19278
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: