Provider Demographics
NPI:1578804787
Name:BALLARD, BRUCE MCNEIL (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:MCNEIL
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 1:2716 PORT OF CALL DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-7151
Mailing Address - Country:US
Mailing Address - Phone:702-254-1924
Mailing Address - Fax:702-476-0017
Practice Address - Street 1:2716 PORT OF CALL DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-7151
Practice Address - Country:US
Practice Address - Phone:702-254-1924
Practice Address - Fax:702-476-0017
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8769207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVA36358Medicare UPIN