Provider Demographics
NPI:1609819317
Name:BALLARD, TIFFANY EILERS (DO)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:EILERS
Last Name:BALLARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4131 SPICEWOOD SPRINGS RD.,
Mailing Address - Street 2:SUITE # I-3
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759
Mailing Address - Country:US
Mailing Address - Phone:512-535-4678
Mailing Address - Fax:512-857-0931
Practice Address - Street 1:4131 SPICEWOOD SPRINGS RD.,
Practice Address - Street 2:SUITE # I-3
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759
Practice Address - Country:US
Practice Address - Phone:512-535-4678
Practice Address - Fax:512-857-0931
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL52362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH91059Medicare UPIN
TX8C8779Medicare ID - Type Unspecified