Provider Demographics
NPI:1437386737
Name:BALLARD, BRAD R (MD)
Entity type:Individual
Prefix:DR
First Name:BRAD
Middle Name:R
Last Name:BALLARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5821 S SPRAGUE CT
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-6903
Mailing Address - Country:US
Mailing Address - Phone:800-664-9225
Mailing Address - Fax:253-396-4260
Practice Address - Street 1:5821 S SPRAGUE CT
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-6903
Practice Address - Country:US
Practice Address - Phone:800-664-9225
Practice Address - Fax:253-396-4260
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61561497207W00000X
CO56524207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE25936OtherSTATE LICENSURE
NE25936OtherSTATE LICENSURE