Healthcare Provider Details

I. General information

NPI: 1134302995
Provider Name (Legal Business Name): VINCENT LEE BALL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 08/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CENTER ATTN: MCHJ-EDME 9040 REID STREET
TACOMA WA
98431-1100
US

IV. Provider business mailing address

MADIGAN ARMY MEDICAL CENTER ATTN: MCHJ-EDME 9040 REID STREET
TACOMA WA
98431-1100
US

V. Phone/Fax

Practice location:
  • Phone: 253-651-6470
  • Fax:
Mailing address:
  • Phone: 253-651-6470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD 60064119
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number23979
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number23979
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: