Provider Demographics
NPI:1134230709
Name:BALLARD, PETER F (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:F
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 1:478 WHIRLAWAY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-9037
Mailing Address - Country:US
Mailing Address - Phone:859-936-9430
Mailing Address - Fax:859-236-2284
Practice Address - Street 1:478 WHIRLAWAY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-9037
Practice Address - Country:US
Practice Address - Phone:859-936-9430
Practice Address - Fax:859-236-2284
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22421207KA0200X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64224215Medicaid
KY000000041698OtherANTHEM PIN
KY000000041698OtherANTHEM PIN
KY64224215Medicaid
KY1672701Medicare ID - Type Unspecified