Basic Information
| Provider Information | |||||||||
| NPI: | 1912438862 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALL | ||||||||
| FirstName: | EMILY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 358 MOUNTAIN SHADOWS RD | ||||||||
| Address2: | |||||||||
| City: | CORRALES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 870487323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5054121780 | ||||||||
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| Practice Location | |||||||||
| Address1: | 933 BRADBURY DR SE STE 2222 | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871064375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052726487 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2017 | ||||||||
| LastUpdateDate: | 07/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | DM2020-0305 | NM | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | MD2020-0305 | NM | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | MD2020-0305 | 01 | NM | NEW MEXICO MEDICAL BOARD | OTHER |