Provider Demographics
NPI:1720020738
Name:BALL, CHARLES W JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:W
Last Name:BALL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1409 MCCANN RD
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-3852
Mailing Address - Country:US
Mailing Address - Phone:903-470-8100
Mailing Address - Fax:903-470-8101
Practice Address - Street 1:1409 MCCANN RD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-3852
Practice Address - Country:US
Practice Address - Phone:903-470-8100
Practice Address - Fax:903-470-8101
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-5265207Q00000X
TXT1294207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR104981001Medicaid
TN626001636OtherUNITED HEALTHCARE
TN10027028OtherUAHC
TN626001636OtherUSA MANAGED CARE
TN626001636OtherBHSG
MS04629898Medicaid
TN3825644Medicaid
TN4135427OtherBLUE CROSS BLUE SHIELD
TN2416091OtherCIGNA
TN626001636OtherHEALTH NOW
TN39809OtherTLC
AR387801YJG2Medicare PIN
TN626001636OtherBHSG