=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881921955
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHERIE BALLARD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2009
-----------------------------------------------------
Last Update Date | 11/11/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2020 NE 62ND COURT
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-892-9730
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2631 EAST OAKLAND PARK BLVD. SUITE 107
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-563-5556
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175L00000X
-----------------------------------------------------
Taxonomy Name | Homeopath
-----------------------------------------------------
License Number | 053735-00
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------