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General NPI Number Information
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NPI Number | 1720020738
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Entity Type | Individual
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Provider Name | CHARLES W BALL JR. MD
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Gender | Male
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 10/03/2025
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Provider Practice Location Address
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Address Line | 1201 W LOOP 281 STE 302
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City | LONGVIEW
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State | TX
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Zip | 75604-2941
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Country | US
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Telephone | 903-470-8100
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Fax | 903-470-8101
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Provider Business Mailing Address
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Address Line | 1201 W LOOP 281 STE 302
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City | LONGVIEW
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State | TX
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Zip | 75604-2941
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Country | US
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Telephone | 903-470-8100
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Fax | 903-470-8101
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | T1294
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | C-5265
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License Number State | AR
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