Provider Demographics
NPI:1609985415
Name:BALLARD, TERRANCE L (MD)
Entity type:Individual
Prefix:DR
First Name:TERRANCE
Middle Name:L
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 1:9065 S PECOS RD STE 190
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-6605
Mailing Address - Country:US
Mailing Address - Phone:702-948-0013
Mailing Address - Fax:
Practice Address - Street 1:9065 S PECOS RD STE 190
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-6605
Practice Address - Country:US
Practice Address - Phone:702-948-0013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7062207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine