Individual
LEVI TAYLOR BALLSTAEDT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O
Contact information
Practice address
3269 N STOCKTON HILL RD, KINGMAN, AZ 86409-3619
(928) 757-0649
Mailing address
3269 N STOCKTON HILL RD, KINGMAN, AZ 86409-3619
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
007719
AZ
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
06/06/2016
Last updated
06/13/2019
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