Provider Demographics
NPI:1598790560
Name:BALL, JEFFREY V (PA)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:V
Last Name:BALL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:JEFF
Other - Middle Name:
Other - Last Name:BALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-302-6500
Mailing Address - Fax:208-302-6535
Practice Address - Street 1:757 E WYTHE CREEK CT
Practice Address - Street 2:
Practice Address - City:KUNA
Practice Address - State:ID
Practice Address - Zip Code:83634-5006
Practice Address - Country:US
Practice Address - Phone:208-302-6500
Practice Address - Fax:208-302-6535
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA228363A00000X
IDPA-228363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805081500Medicaid
S98274Medicare UPIN
ID1666446Medicare ID - Type Unspecified