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General NPI Number Information
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NPI Number | 1386134419
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Entity Type | Individual
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Provider Name | DAVID ADRIAN BALLACK DO
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Gender | Male
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Dates
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Enumeration Date | 05/15/2018
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 400 HEALTH PARK BLVD
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5784
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Country | US
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Telephone | 904-819-5155
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 100183
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City | GAINESVILLE
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State | FL
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Zip | 32610-0183
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Country | US
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Telephone | 352-392-0104
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Fax | 352-392-8217
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 17707
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License Number State | FL
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