Provider Demographics
NPI:1356792360
Name:BALL, JEFFREY ADAM (PA-C)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ADAM
Last Name:BALL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:779 E 980 N
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-9488
Mailing Address - Country:US
Mailing Address - Phone:801-831-9211
Mailing Address - Fax:
Practice Address - Street 1:1244 N MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-9839
Practice Address - Country:US
Practice Address - Phone:435-882-3968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53532363A00000X
UT9614663-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant