Provider Demographics
NPI:1548010986
Name:BALLARD, BENJAMIN THOMAS
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:THOMAS
Last Name:BALLARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7218 COVEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-2623
Mailing Address - Country:US
Mailing Address - Phone:214-563-6396
Mailing Address - Fax:
Practice Address - Street 1:1333 MOURSUND ST STE 120
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3408
Practice Address - Country:US
Practice Address - Phone:713-797-7429
Practice Address - Fax:713-486-0966
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program