Provider Demographics
NPI:1841447950
Name:BALLARD, BROOKE LAURA (MD)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:LAURA
Last Name:BALLARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 RANCHEROS DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-2976
Mailing Address - Country:US
Mailing Address - Phone:760-750-1902
Mailing Address - Fax:760-750-1906
Practice Address - Street 1:277 RANCHEROS DR STE 101
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-2976
Practice Address - Country:US
Practice Address - Phone:760-750-1902
Practice Address - Fax:760-750-1906
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104161207X00000X
FLTRN#17204207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery