Individual
BALLARD GLENN BLAIR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M
Contact information
Practice address
375 BRIDGEPORT AVE, SHELTON, CT 06484
(203) 929-5559
(203) 929-5277
Mailing address
375 BRIDGEPORT AVE, SHELTON, CT 06484
(203) 929-5559
(203) 929-5277
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
CT000419
CT
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
00419
CT
213ER0200X
Radiology Podiatrist
00419
CT
213ES0103X
Foot & Ankle Surgery Podiatrist
00419
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004070918
—
CT
Enumeration date
08/07/2006
Last updated
09/04/2013
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