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General NPI Number Information
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NPI Number | 1821075730
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Entity Type | Individual
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Provider Name | TIMOTHY D BALLARD M.D
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Gender | Male
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Dates
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Enumeration Date | 12/30/2005
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Last Update Date | 05/22/2014
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Provider Practice Location Address
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Address Line | 4881 SUGAR MAPLE DR BLDG 830
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City | WRIGHT PATTERSON AFB
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State | OH
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Zip | 45433-5529
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Country | US
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Telephone | 937-257-1942
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Fax |
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Provider Business Mailing Address
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Address Line | 4881 SUGAR MAPLE DR BLDG 830
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City | WRIGHT PATTERSON AFB
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State | OH
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Zip | 45433-5529
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Country | US
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Telephone | 937-257-1942
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35.088367
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 35-88367
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License Number State | OH
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