Healthcare Provider Details

I. General information

NPI: 1942367040
Provider Name (Legal Business Name): GREGORY PAUL BALLARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 01/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19550 E 39TH ST S SUITE 230
INDEPENDENCE MO
64057-2358
US

IV. Provider business mailing address

19550 E 39TH ST S SUITE 230
INDEPENDENCE MO
64057-2358
US

V. Phone/Fax

Practice location:
  • Phone: 816-795-6630
  • Fax: 816-795-6898
Mailing address:
  • Phone: 816-795-6630
  • Fax: 816-795-6898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0431759
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number01062401A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2007004694
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: