MEDICARE: DR. KENNETH BALLARD D.O.

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	D1386	TX

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	00A301	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1447347810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH BALLARD D.O.

Provider Business Mailing Address
First Line	:	1318 TELEPHONE RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77023-3631
Country	:	US
Telephone Number	:	713-923-1866
Fax Number	:	713-923-4031

Provider Business Practice Location Address
First Line	:	1318 TELEPHONE RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77023-3631
Country	:	US
Telephone Number	:	713-923-1866
Fax Number	:	713-923-4031

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	06/17/2010

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