Basic Information
| Provider Information | |||||||||
| NPI: | 1902844269 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALLAS | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15530 E. BRONCOS PARKWAY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CENTENNIAL | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801127111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7208512000 | ||||||||
| FaxNumber: | 7208512009 | ||||||||
| Practice Location | |||||||||
| Address1: | 15530 E. BRONCOS PARKWAY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CENTENNIAL | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801127111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7208512000 | ||||||||
| FaxNumber: | 7208512009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 12/12/2018 | ||||||||
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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 | 363AS0400X | 1715 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | MB0934958 | 01 | CO | DEA | OTHER | 44870043 | 05 | CO | MEDICAID |