Basic Information
| Provider Information | |||||||||
| NPI: | 1639515711 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALL | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 35 MILES ST | ||||||||
| Address2: | |||||||||
| City: | DAMARISCOTTA | ||||||||
| State: | ME | ||||||||
| PostalCode: | 045434047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2075634146 | ||||||||
| FaxNumber: | 2075633717 | ||||||||
| Practice Location | |||||||||
| Address1: | 592 WEST MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | WALDOBORO | ||||||||
| State: | ME | ||||||||
| PostalCode: | 045726023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078326394 | ||||||||
| FaxNumber: | 2078324392 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2013 | ||||||||
| LastUpdateDate: | 12/19/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | MD21254 | ME | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.