1437386737 NPI number — DR. BRAD R BALLARD MD

Table of content: DR. BRAD R BALLARD MD (NPI 1437386737)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437386737 NPI number — DR. BRAD R BALLARD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALLARD
Provider First Name:
BRAD
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437386737
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5821 S SPRAGUE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98409-6903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-664-9225
Provider Business Mailing Address Fax Number:
253-396-4260

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5821 S SPRAGUE CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98409-6903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-664-9225
Provider Business Practice Location Address Fax Number:
253-396-4260
Provider Enumeration Date:
06/15/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  MD61561497 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207W00000X , with the licence number: 56524 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 25936 . This is a "STATE LICENSURE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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