Provider Demographics
NPI:1891794970
Name:BALL, DEAN R (DO)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:R
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:PO BOX 182255
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43218-2255
Mailing Address - Country:US
Mailing Address - Phone:614-430-5730
Mailing Address - Fax:
Practice Address - Street 1:7067 TIFFANY BLVD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44514-1993
Practice Address - Country:US
Practice Address - Phone:330-629-2366
Practice Address - Fax:330-629-2634
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH340059212085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341843192003OtherMEDICAL MUTUAL
OH000000168556OtherANTHEM
OH0972532Medicaid
OH1601331OtherUNITED HEALTH
OH0972532Medicaid
OHBA0761482Medicare ID - Type Unspecified