Healthcare Provider Details

I. General information

NPI: 1730700535
Provider Name (Legal Business Name): JONATHAN DAVID BALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2020
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 STANTON L YOUNG BLVD AAT 9432
OKC OK
73104
US

IV. Provider business mailing address

1515 DOWNING ST
OKLAHOMA CITY OK
73120-1323
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-6308
  • Fax:
Mailing address:
  • Phone: 405-933-3309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number41507
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: