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Individual
JEFFREY LAWRENCE BALLARD
Active
Individual
JEFFREY LAWRENCE BALLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
G61836
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G618360
BLUE SHIELD OF CA
—
05
—
00G618360
—
CA
01
—
00G618360 M46
CALOPTIMA
—
01
—
050069CD43675
TRAILBLAZER
—
01
—
P00139413
RAILROAD MEDICARE
—
Enumeration date
08/02/2005
Last updated
08/18/2008
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