Individual
ETHAN BALLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
900 NE 10TH ST, OKLAHOMA CITY, OK 73104-5420
(405) 271-6110
Mailing address
577 MOODY ST, GOSNELL, AR 72315-6122
(870) 623-4007
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
43505
OK
Other
Enumeration date
06/05/2024
Last updated
06/05/2024
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