Provider Demographics
NPI:1689624488
Name:BALLARD, LAURI (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURI
Middle Name:
Last Name:BALLARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 CITY POINT DR STE 201
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-8338
Mailing Address - Country:US
Mailing Address - Phone:817-284-8222
Mailing Address - Fax:817-595-5718
Practice Address - Street 1:4300 CITY POINT DR
Practice Address - Street 2:STE 200
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-8380
Practice Address - Country:US
Practice Address - Phone:817-255-1940
Practice Address - Fax:817-255-1977
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3917207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152493603OtherMEDICAID - TARRANT
TX8050B6OtherBCBS
TX152493601Medicaid
TX8050B6OtherBCBS
TXP01423732OtherRAILROAD MEDICARE PTAN
TX370418YNGSMedicare PIN
TXH59768Medicare UPIN