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NPI Code Detail

MEDICARE: BRUCE BALLARD CRNA

MEDICARE: BRUCE BALLARD CRNA
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
1367500000XCertified Registered Nurse Anesthetist706059TX

General Provider Information

NPI Number : 1821367863
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRUCE BALLARD CRNA
Provider Business Mailing Address
First Line : 4100 INTERNATIONAL PLZ
Second Line : SUITE 600
City : FORT WORTH
State : TX
Zip : 76109-4820
Country : US
Telephone Number : 817-529-1157
Fax Number : 817-877-0350
Provider Business Practice Location Address
First Line : 4100 INTERNATIONAL PLZ
Second Line : SUITE 600
City : FORT WORTH
State : TX
Zip : 76109-4820
Country : US
Telephone Number : 817-529-1157
Fax Number : 817-877-0350
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2011
Last Update Date : 12/20/2011

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