Provider Demographics
NPI:1871592477
Name:BALLOW, EDWARD B (DPM)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:B
Last Name:BALLOW
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 S TAMARAC DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-1419
Mailing Address - Country:US
Mailing Address - Phone:303-758-9031
Mailing Address - Fax:303-758-7643
Practice Address - Street 1:3525 S TAMARAC DR
Practice Address - Street 2:SUITE 300
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-1419
Practice Address - Country:US
Practice Address - Phone:303-758-9031
Practice Address - Fax:303-758-7643
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO337213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC11608Medicare PIN
COT60235Medicare UPIN
CO1114620001Medicare NSC