Provider Demographics
NPI:1083100788
Name:DAVID W BALL MD INTERNAL MEDICINE PLLC
Entity Type:Organization
Organization Name:DAVID W BALL MD INTERNAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-330-2081
Mailing Address - Street 1:5407 NEW COPELAND RD STE 200
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-3951
Mailing Address - Country:US
Mailing Address - Phone:903-330-2081
Mailing Address - Fax:903-630-9309
Practice Address - Street 1:5407 NEW COPELAND RD STE 200
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-3951
Practice Address - Country:US
Practice Address - Phone:903-330-2081
Practice Address - Fax:903-630-9309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3980207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty