Healthcare Provider Details

I. General information

NPI: 1659804664
Provider Name (Legal Business Name): DR. JOHN PARKER BALLENTINE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 E MILLTOWN RD STE 105
WOOSTER OH
44691-1276
US

IV. Provider business mailing address

128 E MILLTOWN RD STE 105
WOOSTER OH
44691-1276
US

V. Phone/Fax

Practice location:
  • Phone: 330-345-8060
  • Fax:
Mailing address:
  • Phone: 330-345-8060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.154684
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: