Provider Demographics
NPI:1447215751
Name:BALL, ROBERT H (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:H
Last Name:BALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 E 3900 S
Mailing Address - Street 2:SUITE 390
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1228
Mailing Address - Country:US
Mailing Address - Phone:801-743-4700
Mailing Address - Fax:801-743-4705
Practice Address - Street 1:1140 E 3900 S
Practice Address - Street 2:SUITE 390
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1228
Practice Address - Country:US
Practice Address - Phone:801-743-4700
Practice Address - Fax:801-743-4705
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT346663-1205207VM0101X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200134020AMedicaid
WY1447215751Medicaid
CO31835716Medicaid
CAE70268Medicare UPIN
ID1100038Medicare PIN
UT805026500Medicare PIN
P00805471Medicare PIN
CO31835716Medicaid