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General NPI Number Information
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NPI Number | 1053330779
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Entity Type | Individual
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Provider Name | GERARD A. BALLANCO JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 539 E PRUDHOMME ST
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City | OPELOUSAS
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State | LA
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Zip | 70570-6499
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Country | US
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Telephone | 337-942-6883
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Fax | 337-942-6830
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Provider Business Mailing Address
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Address Line | 460 JUDICE RD
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City | SUNSET
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State | LA
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Zip | 70584-5156
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Country | US
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Telephone | 504-352-6078
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 025645
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License Number State | LA
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