Individual
PATRICK L BALLOU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5330 S HIGHWAY 95, FORT MOHAVE, AZ 86426-9225
(928) 788-7065
Mailing address
1631 W BURNSIDE TRL, PHOENIX, AZ 85085-8071
(307) 977-4945
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4900
AZ
Other
Enumeration date
09/08/2011
Last updated
04/11/2018
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