Provider Demographics
NPI:1437127362
Name:BALLOT, BRYAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:A
Last Name:BALLOT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 FOUNTAIN PKWY N
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-1285
Mailing Address - Country:US
Mailing Address - Phone:727-575-8006
Mailing Address - Fax:727-575-8094
Practice Address - Street 1:140 FOUNTAIN PKWY N
Practice Address - Street 2:SUITE 600
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-1285
Practice Address - Country:US
Practice Address - Phone:727-575-8006
Practice Address - Fax:727-575-8094
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3K742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry