Provider Demographics
NPI:1982854980
Name:BALLARD, PATRICK E (DO)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:E
Last Name:BALLARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 805
Mailing Address - Street 2:
Mailing Address - City:CRAIG
Mailing Address - State:AK
Mailing Address - Zip Code:99921-0805
Mailing Address - Country:US
Mailing Address - Phone:907-826-3257
Mailing Address - Fax:907-826-3259
Practice Address - Street 1:1800 CRAIG-KLAWOCK RD
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:AK
Practice Address - Zip Code:99921-0000
Practice Address - Country:US
Practice Address - Phone:907-826-3257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4962207Q00000X
AK7047207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine