Individual
DR. THOMAS W BALLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 W TIETAN ST, WALLA WALLA, WA 99362-4445
(509) 525-3720
(509) 522-1593
Mailing address
206 BAYWIND DR, NICEVILLE, FL 32578-4802
(850) 564-1030
(850) 564-1039
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
47232
FL
2085R0202X
Diagnostic Radiology Physician
62466
MN
2085R0202X
Diagnostic Radiology Physician
70118
WI
2085R0202X
Diagnostic Radiology Physician
MD00026303
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
044157100
—
FL
Enumeration date
01/13/2006
Last updated
01/22/2019
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