Individual
MARK BALLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2 TAMPA GENERAL CIR, STC 5TH FLOOR, TAMPA, FL 33606-3603
(727) 767-4150
(727) 767-8532
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
(813) 974-2201
(813) 974-2812
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
174470-1
NY
2080P0201X
Pediatric Allergy/Immunology Physician
174470
NY
2080P0201X
Pediatric Allergy/Immunology Physician
Primary
ME112011
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00010009301
UNIVERA
—
01
—
000510824001
BC/BS
—
05
—
0011295550001
—
PA
05
—
008130000
—
FL
05
—
01084606
—
NY
01
—
0207420
IHA
—
01
—
040426000993
FIDELIS
—
01
—
14P6J
BLUE CROSS BLUE SHIELD
FL
Enumeration date
06/21/2006
Last updated
10/27/2020
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