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General NPI Number Information
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NPI Number | 1992904338
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Entity Type | Organization
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Legal Business Name | PETER G BALLAS II MD PA
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Dates
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Enumeration Date | 07/16/2007
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Last Update Date | 06/30/2010
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Provider Practice Location Address
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Address Line | 1905 CLINT MOORE RD SUITE 215
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City | BOCA RATON
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State | FL
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Zip | 33496-2658
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Country | US
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Telephone | 561-989-9002
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Fax | 561-994-9135
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Provider Business Mailing Address
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Address Line | 1905 CLINT MOORE RD SUITE 215
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City | BOCA RATON
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State | FL
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Zip | 33496-2658
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Country | US
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Telephone | 561-989-9002
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Fax | 561-994-9135
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PETER G BALLAS II
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Credential | MD PA
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Telephone | 561-989-9002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME0046838
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License Number State | FL
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