Provider Demographics
NPI:1003864893
Name:BALL, JAMES BRADLEY (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:BRADLEY
Last Name:BALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:
Other - Last Name:BALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4900 S MONACO ST STE 210
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3487
Mailing Address - Country:US
Mailing Address - Phone:303-832-2344
Mailing Address - Fax:303-832-3721
Practice Address - Street 1:2055 N HIGH ST STE 340
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-5545
Practice Address - Country:US
Practice Address - Phone:303-832-2344
Practice Address - Fax:303-832-3721
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2024-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0046004207PP0204X
CO46004208000000X, 2080P0207X
AL256292080P0207X
TN701312080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO37428764Medicaid
NE10025570100Medicaid
WY1003864893Medicaid
AL113679Medicaid
WY132927800Medicaid
NM92281371Medicaid
AL009935727Medicaid
SD7756690Medicaid
CO473240ZS40Medicare PIN
WY132927800Medicaid