Provider Demographics
NPI:1720751183
Name:BALL, PATRICK DOUGLAS
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:DOUGLAS
Last Name:BALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 GEORGE BUSH DR W APT 1117
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-2979
Mailing Address - Country:US
Mailing Address - Phone:903-393-8841
Mailing Address - Fax:
Practice Address - Street 1:503 GEORGE BUSH DR W APT 1117
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-2979
Practice Address - Country:US
Practice Address - Phone:903-393-8841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program