Provider Demographics
NPI:1215183439
Name:JEFFREY BALLARD, M.D., APC
Entity Type:Organization
Organization Name:JEFFREY BALLARD, M.D., APC
Other - Org Name:JEFFREY BALLARD, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-484-2783
Mailing Address - Street 1:2486 PONDEROSA DR N
Mailing Address - Street 2:D 114
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-2469
Mailing Address - Country:US
Mailing Address - Phone:805-484-2783
Mailing Address - Fax:805-987-8519
Practice Address - Street 1:2486 PONDEROSA DR N
Practice Address - Street 2:D 114
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2469
Practice Address - Country:US
Practice Address - Phone:805-484-2783
Practice Address - Fax:805-987-8519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-08
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83822207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5943390001Medicare NSC
CAG51170Medicare UPIN
CADC832AMedicare PIN
CAG83822Medicare PIN