Baller, Jeffrey David

Baller, Jeffrey David is an individual health care provider with primary practice located at 2600 Kanell Blvd , Poplar Bluff MO 63901-3001. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery, which is considered as his primary health care specialty. Baller, Jeffrey David can be contacted via phone (573) 785-4546.

Contact Information

Primary practice address
2600 Kanell Blvd Poplar Bluff MO 63901-3001
Phone: (573) 785-4546
Fax: (573) 785-6959
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X 2009020599 Missouri

Profile Details

NPI number 1710981519
LBN Legal business name Baller, Jeffrey David
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 9th, 2005
Last updated Aug 2nd, 2019 - 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 1710981519 NPPES
Missouri MEDICAID 1710981519

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