Provider Demographics
NPI:1447236831
Name:BALL, PATRICK BRIAN (DO)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:BRIAN
Last Name:BALL
Suffix:
Gender:M
Credentials:DO
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:PO BOX 267
Mailing Address - Street 2:14395 STATE ROUTE 93
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-0267
Mailing Address - Country:US
Mailing Address - Phone:740-286-3034
Mailing Address - Fax:740-288-7682
Practice Address - Street 1:14395 STATE ROUTE 93
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-9360
Practice Address - Country:US
Practice Address - Phone:740-286-3034
Practice Address - Fax:740-288-7682
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003138B207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0463921Medicaid
A79986Medicare UPIN
OH0463921Medicaid