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NPI Code Detail

MEDICARE: DR. TIMOTHY CROSS BALLARD M.D.

MEDICARE:  DR. TIMOTHY CROSS BALLARD  M.D.
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
1208600000XSurgery PhysicianA94006CA
2207P00000XEmergency Medicine PhysicianA94006CA

General Provider Information

NPI Number : 1710090816
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TIMOTHY CROSS BALLARD M.D.
Provider Business Mailing Address
First Line : 5325 NEWCASTLE AVE
Second Line : UNIT 245
City : ENCINO
State : CA
Zip : 91316-3081
Country : US
Telephone Number : 818-708-7674
Fax Number : 818-708-7674
Provider Business Practice Location Address
First Line : 401 S FAIR OAKS AVE
Second Line :
City : PASADENA
State : CA
Zip : 91105-2603
Country : US
Telephone Number : 626-795-2244
Fax Number : 626-795-5378
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2006
Last Update Date : 12/18/2024

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Directions to “ DR. TIMOTHY CROSS BALLARD M.D.” Practice Location

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