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Individual

DR. SHANA LYNN BALLOW

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DO

Contact information

Practice address
2823 FRESNO ST, FRESNO, CA 93721-1324
(559) 459-3770
Mailing address
2625 E DIVISADERO ST, FRESNO, CA 93721-1431
(559) 443-2682
(559) 443-2681

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
20A10299
CA
2086S0127X
Trauma Surgery Physician
Primary
20A10299
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1538417381
CA
Enumeration date
07/15/2011
Last updated
01/09/2020
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