Healthcare Provider Details

I. General information

NPI: 1598790560
Provider Name (Legal Business Name): JEFFREY V BALL PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JEFF BALL PA

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 E WYTHE CREEK CT
KUNA ID
83634-5006
US

IV. Provider business mailing address

3340 E GOLDSTONE WAY
MERIDIAN ID
83642-1026
US

V. Phone/Fax

Practice location:
  • Phone: 208-302-6500
  • Fax: 208-302-6535
Mailing address:
  • Phone: 208-302-6500
  • Fax: 208-302-6535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA228
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-228
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: