MEDICARE: ELIZABETH J BALLARD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	108709	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043284730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH J BALLARD MD

Provider Business Mailing Address
First Line	:	18452 BUSINESS 13
Second Line	:
City	:	BRANSON WEST
State	:	MO
Zip	:	65737-9609
Country	:	US
Telephone Number	:	417-272-8911
Fax Number	:	417-272-3900

Provider Business Practice Location Address
First Line	:	18452 BUSINESS 13
Second Line	:
City	:	BRANSON WEST
State	:	MO
Zip	:	65737-9609
Country	:	US
Telephone Number	:	417-272-8911
Fax Number	:	417-272-3900

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	09/20/2016

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