MEDICARE: DR. DERICK ALAN BALL DPM

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	213ES0131X	Foot Surgery Podiatrist	E3329	CA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346299716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DERICK ALAN BALL DPM

Provider Business Mailing Address
First Line	:	13624 HAWTHORNE BLVD
Second Line	:	SUITE 206
City	:	HAWTHORNE
State	:	CA
Zip	:	90250-5818
Country	:	US
Telephone Number	:	310-675-0900
Fax Number	:	310-675-0904

Provider Business Practice Location Address
First Line	:	13624 HAWTHORNE BLVD
Second Line	:	SUITE 206
City	:	HAWTHORNE
State	:	CA
Zip	:	90250-5818
Country	:	US
Telephone Number	:	310-675-0900
Fax Number	:	310-675-0904

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	04/08/2008

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