Individual
BALLARD GLENN BLAIR
Active
Individual
BALLARD GLENN BLAIR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M
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
Update your record
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