Healthcare Provider Details

I. General information

NPI: 1043284730
Provider Name (Legal Business Name): ELIZABETH J BALLARD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18452 BUSINESS 13
BRANSON WEST MO
65737-9609
US

IV. Provider business mailing address

18452 BUSINESS 13
BRANSON WEST MO
65737-9609
US

V. Phone/Fax

Practice location:
  • Phone: 417-272-8911
  • Fax: 417-272-3900
Mailing address:
  • Phone: 417-272-8911
  • Fax: 417-272-3900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number108709
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: