Provider Demographics
NPI:1699782391
Name:BALLARD, DEBORAH ANN (MD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:ANN
Last Name:BALLARD
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 1:3945 NANZ AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4937
Mailing Address - Country:US
Mailing Address - Phone:502-890-6729
Mailing Address - Fax:
Practice Address - Street 1:3945 NANZ AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4937
Practice Address - Country:US
Practice Address - Phone:502-593-0327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY26476207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50021488OtherPASSPORT
KY000000227457OtherANTHEM
IN200910970Medicaid
KY64264765Medicaid
KY3553349000OtherPASSPORT ADVANTAGE
KY3553349000OtherPASSPORT ADVANTAGE
KY000000227457OtherANTHEM
KY50021488OtherPASSPORT
IN630960BBMedicare PIN