Healthcare Provider Details

I. General information

NPI: 1104866409
Provider Name (Legal Business Name): DONALD E BALLARD PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 01/11/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 PORTLAND WAY S
GALION OH
44833-2312
US

IV. Provider business mailing address

4750 HEMPSTEAD STATION DR
KETTERING OH
45429-5164
US

V. Phone/Fax

Practice location:
  • Phone: 419-468-4841
  • Fax: 419-462-0500
Mailing address:
  • Phone: 800-875-0136
  • Fax: 937-619-4231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50000899
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: