Provider Demographics
NPI:1467913772
Name:BALLMAN, ERIC
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:BALLMAN
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 1:4545 E 9TH AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3902
Mailing Address - Country:US
Mailing Address - Phone:303-388-2922
Mailing Address - Fax:303-388-2962
Practice Address - Street 1:4545 E 9TH AVE STE 120
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3902
Practice Address - Country:US
Practice Address - Phone:303-388-2922
Practice Address - Fax:303-388-2962
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0066158208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery