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Organization

BALLARD MEDICAL CORPORATION

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MORRIS ROBERT BALLARD M.D. (PRESIDENT)
(530) 244-9750
Entity
Organization

Contact information

Practice address
1115 WHISKEYTOWN CT, SUITE B, REDDING, CA 96001-0227
(530) 244-9750
(530) 244-0960
Mailing address
1115 WHISKEYTOWN CT, SUITE B, REDDING, CA 96001-0227
(530) 244-9750
(530) 244-0960

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G017510
CA
207Q00000X
Family Medicine Physician
G14717
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
GR0001720
CA
01
ZZZ89207Z
BLUE SHIELD PROVIDER #
CA
Enumeration date
11/10/2006
Last updated
08/22/2020
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