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Individual

BERNARD H BALLOU

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
3720 NW 83RD ST, GAINESVILLE, FL 32606-5603
(352) 336-3050
Mailing address
PO BOX 358720, GAINESVILLE, FL 32635-8720
(352) 331-6410
(352) 331-6410

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME0049070
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
048165300
FL
Enumeration date
08/04/2006
Last updated
05/05/2009
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