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General NPI Number Information
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NPI Number | 1336589936
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Entity Type | Organization
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Legal Business Name | BALLARD GYNECOLOGY PROF LLC
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Dates
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Enumeration Date | 06/27/2013
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Last Update Date | 06/27/2013
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Provider Practice Location Address
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Address Line | 208 FEDERAL AVE
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City | RAPID CITY
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State | SD
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Zip | 57702-2326
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Country | US
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Telephone | 605-791-4442
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Fax | 605-791-4449
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Provider Business Mailing Address
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Address Line | 208 FEDERAL AVE
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City | RAPID CITY
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State | SD
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Zip | 57702-2326
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Country | US
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Telephone | 605-791-4442
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Fax | 605-791-4449
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK C. BALLARD
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Credential | M.D.
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Telephone | 605-791-4442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 4683
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License Number State | SD
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