Provider Demographics
NPI:1366989477
Name:BALLARD, JEREMY
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:BALLARD
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 1:7025 N SCOTTSDALE RD
Mailing Address - Street 2:SUITE #302
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-3675
Mailing Address - Country:US
Mailing Address - Phone:480-657-6007
Mailing Address - Fax:480-657-7020
Practice Address - Street 1:7025 N SCOTTSDALE RD
Practice Address - Street 2:SUITE #302
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85253-3675
Practice Address - Country:US
Practice Address - Phone:480-657-6007
Practice Address - Fax:480-657-7020
Is Sole Proprietor?:No
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist