Provider Demographics
NPI:1710090816
Name:BALLARD, TIMOTHY CROSS (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:CROSS
Last Name:BALLARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5325 NEWCASTLE AVE
Mailing Address - Street 2:UNIT 245
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3081
Mailing Address - Country:US
Mailing Address - Phone:818-708-7674
Mailing Address - Fax:818-708-7674
Practice Address - Street 1:401 S FAIR OAKS AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2603
Practice Address - Country:US
Practice Address - Phone:626-795-2244
Practice Address - Fax:626-795-5378
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA94006208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery