Provider Demographics
NPI:1306928858
Name:BALLINGER, ANNE T (MD)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:T
Last Name:BALLINGER
Suffix:
Gender:F
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:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85636-0327
Mailing Address - Country:US
Mailing Address - Phone:520-459-0012
Mailing Address - Fax:
Practice Address - Street 1:2240 WINROW AVENUE
Practice Address - Street 2:USA MEDDAC,RWBAHC
Practice Address - City:FORT HUACHUCA
Practice Address - State:AZ
Practice Address - Zip Code:85613-7079
Practice Address - Country:US
Practice Address - Phone:520-533-2555
Practice Address - Fax:520-533-5603
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15593171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider