Basic Information
| Provider Information | |||||||||
| NPI: | 1679596795 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALL | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2147 | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339022147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2393438220 | ||||||||
| FaxNumber: | 2393438221 | ||||||||
| Practice Location | |||||||||
| Address1: | 1569 MATTHEW DR | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2393438220 | ||||||||
| FaxNumber: | 2393438221 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 03/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME129967 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01614240 | 05 | NY | MEDICAID | P010000065 | 01 | EXCELLUS BCBS ROCHESTER N | OTHER | 0406844 | 01 | INDEPENDENT HEALTH | OTHER | 102410400 | 05 | FL | MEDICAID | 000523605002 | 01 | BCBS WESTERN NY | OTHER | 102906BJ | 01 | PREFERRED CARE | OTHER | 7702405 | 01 | MVP | OTHER | 00010009201 | 01 | UNIVERA HEALTHCARE | OTHER | 5902805 | 01 | GHI | OTHER |