Provider Demographics
NPI:1497953954
Name:BALLARD, DEWEY PHILIP (MD)
Entity Type:Individual
Prefix:DR
First Name:DEWEY
Middle Name:PHILIP
Last Name:BALLARD
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 1:3409 ELM SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-2754
Mailing Address - Country:US
Mailing Address - Phone:479-927-2100
Mailing Address - Fax:479-927-2211
Practice Address - Street 1:3409 ELM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-2754
Practice Address - Country:US
Practice Address - Phone:479-927-2100
Practice Address - Fax:479-927-2211
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8328207R00000X
ARE-7366207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C51800Medicare UPIN