Provider Demographics
NPI:1043284730
Name:BALLARD, ELIZABETH J (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:BALLARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18452 BUSINESS 13
Mailing Address - Street 2:
Mailing Address - City:BRANSON WEST
Mailing Address - State:MO
Mailing Address - Zip Code:65737-9609
Mailing Address - Country:US
Mailing Address - Phone:417-272-8911
Mailing Address - Fax:417-272-3900
Practice Address - Street 1:18452 BUSINESS 13
Practice Address - Street 2:
Practice Address - City:BRANSON WEST
Practice Address - State:MO
Practice Address - Zip Code:65737-9609
Practice Address - Country:US
Practice Address - Phone:417-272-8911
Practice Address - Fax:417-272-3900
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO108709207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203807904Medicaid
MOG76685Medicare UPIN
MO001013682Medicare ID - Type Unspecified
MO203807904Medicaid