Provider Demographics
NPI:1790895514
Name:BALLARD, JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:BALLARD
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 1:2486 N PONDEROSA DR
Mailing Address - Street 2:D-114
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-2376
Mailing Address - Country:US
Mailing Address - Phone:805-484-2783
Mailing Address - Fax:805-987-8519
Practice Address - Street 1:2486 N PONDEROSA DR
Practice Address - Street 2:D-114
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2376
Practice Address - Country:US
Practice Address - Phone:805-484-2783
Practice Address - Fax:805-987-8519
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83822207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG51170Medicare UPIN
CA5943390001Medicare NSC
CAG83822Medicare PIN
CAW268Medicare PIN
CADC831ZMedicare PIN