Healthcare Provider Details

I. General information

NPI: 1134230709
Provider Name (Legal Business Name): PETER F. BALLARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

478 WHIRLAWAY DR SUITE 100
DANVILLE KY
40422-9037
US

IV. Provider business mailing address

478 WHIRLAWAY DR SUITE 100
DANVILLE KY
40422-9037
US

V. Phone/Fax

Practice location:
  • Phone: 859-936-9430
  • Fax: 859-236-2284
Mailing address:
  • Phone: 859-936-9430
  • Fax: 859-236-2284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number22421
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number22421
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: