Individual
DR. JEFFREY DAVID BALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
2600 KANELL BLVD, POPLAR BLUFF, MO 63901-3001
(573) 785-4546
(573) 785-6959
Mailing address
2600 KANELL BLVD, POPLAR BLUFF, MO 63901-3001
(573) 785-4546
(573) 785-6959
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
2009020599
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710981519
—
MO
Enumeration date
06/09/2005
Last updated
08/02/2019
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