Individual
MARK W BALLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
195 FORE RIVER PKWY STE 480, PORTLAND, ME 04102-2787
(207) 773-3937
(207) 773-0801
Mailing address
195 FORE RIVER PKWY STE 480, PORTLAND, ME 04102-2787
(207) 773-3937
(207) 773-0801
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
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