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Individual

MARK W BALLES

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
014047
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
033680
BCBS STAR NUMBER
ME
05
130920000
ME
05
298300099
ME
01
R0007
BCBS GROUP NUMBER
ME
Enumeration date
01/25/2006
Last updated
01/07/2010
Update your record

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