Provider Demographics
NPI:1134324528
Name:BALLARD, JAMES ROBERT (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:BALLARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 NE 27TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7760
Mailing Address - Country:US
Mailing Address - Phone:541-313-8111
Mailing Address - Fax:
Practice Address - Street 1:1550 NE 27TH ST STE 100
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7760
Practice Address - Country:US
Practice Address - Phone:541-313-8111
Practice Address - Fax:541-313-8111
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT289654-12052086S0129X
OR390200000X
ORMD1970642086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program