Individual
DAVID WAYNE BALLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
NAVAL UNDERSEA MEDICAL INSTITUTE, SUBMARINE BASE, GROTON, CT 06349-5159
(860) 694-2876
Mailing address
8 SHERWOOD TRACE, GALES FERRY, CT 06335
(860) 514-0873
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
12/06/2006
Last updated
12/29/2008
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