Healthcare Provider Details

I. General information

NPI: 1619166378
Provider Name (Legal Business Name): DR. COLLIN E. BALL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DR. COLLIN E. BALL

II. Dates (important events)

Enumeration Date: 10/18/2007
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 LONDON MOUNTAIN VIEW DR
LONDON KY
40741-6601
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 606-864-0770
  • Fax: 606-864-1461
Mailing address:
  • Phone: 606-330-7840
  • Fax: 606-330-7825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number308
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: