Individual
MATTHEW BALLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
18701 N 67TH AVE, GLENDALE, AZ 85308-7100
(503) 580-1898
Mailing address
1937 N 1640 W, PROVO, UT 84604-5626
(503) 580-1898
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/09/2021
Last updated
05/17/2021
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