Individual
GARY BALLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2740 W LAKE MENDOCINO DR, UKIAH, CA 95482-3044
(707) 462-9028
Mailing address
2740 W LAKE MENDOCINO DR, UKIAH, CA 95482-3044
(707) 462-9028
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
DR-14824
CO
2085R0202X
Diagnostic Radiology Physician
Primary
G26847
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
53838068
—
CO
Enumeration date
07/20/2006
Last updated
06/06/2011
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