Provider Demographics
NPI:1447347810
Name:BALLARD, KENNETH (DO)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:BALLARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 TELEPHONE RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77023-3631
Mailing Address - Country:US
Mailing Address - Phone:713-923-1866
Mailing Address - Fax:713-923-4031
Practice Address - Street 1:1318 TELEPHONE RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77023-3631
Practice Address - Country:US
Practice Address - Phone:713-923-1866
Practice Address - Fax:713-923-4031
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD1386207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127044901Medicaid
TX00A301OtherBCBS
TX127044901Medicaid