Provider Demographics
NPI:1134652639
Name:DEBORAH ANN BALLARD MD, INTEGRATIVE MEDICINE PLLC
Entity Type:Organization
Organization Name:DEBORAH ANN BALLARD MD, INTEGRATIVE MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-890-6729
Mailing Address - Street 1:3945 NANZ AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4937
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3945 NANZ AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4937
Practice Address - Country:US
Practice Address - Phone:502-593-0327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-11
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty