MEDICARE: DR. EDWARD B BALLOW 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	213E00000X	Podiatrist	337	CO

General Provider Information

NPI Number	:	1871592477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD B BALLOW DPM

Provider Business Mailing Address
First Line	:	3525 S TAMARAC DR
Second Line	:	SUITE 300
City	:	DENVER
State	:	CO
Zip	:	80237-1419
Country	:	US
Telephone Number	:	303-758-9031
Fax Number	:	303-758-7643

Provider Business Practice Location Address
First Line	:	3525 S TAMARAC DR
Second Line	:	SUITE 300
City	:	DENVER
State	:	CO
Zip	:	80237-1419
Country	:	US
Telephone Number	:	303-758-9031
Fax Number	:	303-758-7643

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	06/03/2013

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