Provider Demographics
NPI:1902067424
Name:BALLARD, PERCY RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:PERCY
Middle Name:RAY
Last Name:BALLARD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1340 BOYLSTON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-4302
Mailing Address - Country:US
Mailing Address - Phone:617-267-0900
Mailing Address - Fax:
Practice Address - Street 1:1340 BOYLSTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-4302
Practice Address - Country:US
Practice Address - Phone:617-267-0900
Practice Address - Fax:617-267-3667
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2013-09-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA2364762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA236476OtherMASSACHUSETTS BOARD OF REGISTRATION IN MEDICINE LIMITED LICENSE