Individual
LYDIA RENE BALLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
950 N PORTER AVE, SUITE #300, NORMAN, OK 73071-6400
(405) 329-0121
(405) 292-6099
Mailing address
950 N PORTER AVE, SUITE #300, NORMAN, OK 73071-6400
(405) 329-0121
(405) 292-6099
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
18425
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100138140B
—
OK
01
—
110218258
RAILROAD MEDICARE
OK
01
—
5222147
AETNA EDI #
OK
Enumeration date
08/03/2005
Last updated
07/15/2010
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