Provider Demographics
NPI:1235293820
Name:BALLIN, JASON SCOTT (DO)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:SCOTT
Last Name:BALLIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 STANFIELD RD.
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-2366
Mailing Address - Country:US
Mailing Address - Phone:937-339-8380
Mailing Address - Fax:
Practice Address - Street 1:5300 FAR HILLS AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-2381
Practice Address - Country:US
Practice Address - Phone:937-312-3820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.012702207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology