Provider Demographics
NPI:1588688378
Name:BALLARD, JOSEPH RAYMOND (CRNA)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:RAYMOND
Last Name:BALLARD
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S BRYAN RD
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6613
Mailing Address - Country:US
Mailing Address - Phone:956-323-1808
Mailing Address - Fax:956-323-1817
Practice Address - Street 1:900 S BRYAN RD
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6613
Practice Address - Country:US
Practice Address - Phone:956-323-1808
Practice Address - Fax:956-323-1817
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX230462367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX028977OtherCOUNCIL RECERTIFICATION #
TX89177CMedicare ID - Type UnspecifiedMEDICARE NUMBER