Provider Demographics
NPI:1740779065
Name:BALL, WILLIAM KOLBY (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:KOLBY
Last Name:BALL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2382 CRAWFORDVILLE HWY STE C
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-1091
Mailing Address - Country:US
Mailing Address - Phone:850-926-2602
Mailing Address - Fax:850-926-2602
Practice Address - Street 1:2382 CRAWFORDVILLE HWY STE C
Practice Address - Street 2:
Practice Address - City:CRAWFORDVILLE
Practice Address - State:FL
Practice Address - Zip Code:32327-1091
Practice Address - Country:US
Practice Address - Phone:850-926-6363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19278207Q00000X
OK6607390200000X
OK0667207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program