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Individual

DR. GREGORY R BALL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
775 POLE LINE RD W, SUITE 315, TWIN FALLS, ID 83301-5814
(208) 814-8750
(208) 814-8937
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
(208) 814-7491

Taxonomy

Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
O0575
ID
207RP1001X
Pulmonary Disease Physician
Primary
O0575
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1407985278
ID
01
P0034096
MCRR
ID
Enumeration date
03/05/2007
Last updated
01/16/2015
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