Organization
BERNARD H. BALLOU MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BERNARD H. BALLOU MD (PHYSICIAN)
(352) 331-6410
Entity
Organization
Contact information
Practice address
3720 NW 83RD ST, GAINESVILLE, FL 32606-5603
(352) 336-3050
Mailing address
PO BOX 358720, GAINESVILLE, FL 32635-8720
(352) 331-6410
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME0049070
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002730300
—
FL
Enumeration date
09/03/2008
Last updated
09/05/2011
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