Provider Demographics
NPI:1003975145
Name:BALL, JOHN HAROLD (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HAROLD
Last Name:BALL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 W BULLDOG BLVD STE 401
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3338
Mailing Address - Country:US
Mailing Address - Phone:801-357-7546
Mailing Address - Fax:801-357-8840
Practice Address - Street 1:395 W BULLDOG BLVD STE 401
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3338
Practice Address - Country:US
Practice Address - Phone:801-357-7546
Practice Address - Fax:801-357-8840
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT349321-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTS18450Medicare UPIN