Provider Demographics
NPI:1104271816
Name:BALLE, KRISTIAN ROYAL (DO)
Entity type:Individual
Prefix:DR
First Name:KRISTIAN
Middle Name:ROYAL
Last Name:BALLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:725 S DOBSON RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5680
Mailing Address - Country:US
Mailing Address - Phone:480-899-7546
Mailing Address - Fax:480-899-7599
Practice Address - Street 1:725 S DOBSON RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5680
Practice Address - Country:US
Practice Address - Phone:480-899-7546
Practice Address - Fax:480-899-7599
Is Sole Proprietor?:No
Enumeration Date:2016-05-01
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ009641207R00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine