Ballard, Richard Dane

Ballard, Richard Dane is an sole proprietor health care provider with primary practice located at 499 Gloster Creek Vlg Ste A2 , Tupelo MS 38801. He recently has only one registered license in Allopathic & Osteopathic Physicians / Interventional Cardiology, which is considered as his primary health care specialty. Ballard, Richard Dane can be contacted via phone (662) 620-6800.

Contact Information

Primary practice address
499 Gloster Creek Vlg Ste A2 Tupelo MS 38801
Phone: (662) 620-6800
Fax: (662) 620-6950
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Interventional Cardiology 207RI0011X 22430 Mississippi

Profile Details

NPI number 1366739054
LBN Legal business name Ballard, Richard Dane
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 1st, 2011
Last updated Sep 18th, 2018 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1366739054 NPPES
Mississippi Other T-2401 TEMPORARY MS MEDICAL LICENSE
Mississippi MEDICAID 05300066 TEMPORARY MS MEDICAL LICENSE

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