Provider Demographics
NPI:1679596795
Name:BALL, THOMAS H (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:H
Last Name:BALL
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:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-8220
Mailing Address - Fax:239-343-8221
Practice Address - Street 1:1569 MATTHEW DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907
Practice Address - Country:US
Practice Address - Phone:239-343-8220
Practice Address - Fax:239-343-8221
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME129967207R00000X
NY2051631208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01614240Medicaid
P010000065OtherEXCELLUS BCBS ROCHESTER N
0406844OtherINDEPENDENT HEALTH
FL102410400Medicaid
000523605002OtherBCBS WESTERN NY
102906BJOtherPREFERRED CARE
7702405OtherMVP
00010009201OtherUNIVERA HEALTHCARE
5902805OtherGHI
7702405OtherMVP