Provider Demographics
NPI:1194909739
Name:BALL, RICHARD (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:BALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6100 PAN AM E FWY
Mailing Address - Street 2:SUITE 455
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3460
Mailing Address - Country:US
Mailing Address - Phone:505-823-1145
Mailing Address - Fax:505-828-1416
Practice Address - Street 1:6100 PAN AM E FWY
Practice Address - Street 2:SUITE 455
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3460
Practice Address - Country:US
Practice Address - Phone:505-823-1145
Practice Address - Fax:505-828-1416
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM79-114207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM12344Medicaid
D43025Medicare UPIN
NM12344Medicaid