Provider Demographics
NPI:1033175724
Name:BALL, LARRY D (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:D
Last Name:BALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 S BUCKEYE
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:KS
Mailing Address - Zip Code:67578-2002
Mailing Address - Country:US
Mailing Address - Phone:620-234-6927
Mailing Address - Fax:620-234-6850
Practice Address - Street 1:602 S BUCKEYE
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:KS
Practice Address - Zip Code:67578-2002
Practice Address - Country:US
Practice Address - Phone:620-234-6927
Practice Address - Fax:620-234-6850
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0412309207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D17392Medicare UPIN
006034Medicare ID - Type Unspecified