Provider Demographics
NPI:1780907188
Name:KENNETH G. BALLARD, D.O., P.A.
Entity type:Organization
Organization Name:KENNETH G. BALLARD, D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:713-923-1866
Mailing Address - Street 1:1318 TELEPHONE RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77023-3631
Mailing Address - Country:US
Mailing Address - Phone:713-923-1866
Mailing Address - Fax:713-923-4031
Practice Address - Street 1:1318 TELEPHONE RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77023-3631
Practice Address - Country:US
Practice Address - Phone:713-923-1866
Practice Address - Fax:713-923-4031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD1386207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCAB3569425OtherDRUG ENFORCEMENT ADMINISTRATION #
DCAB3569425OtherDRUG ENFORCEMENT ADMINISTRATION #
TXA65323Medicare UPIN