Basic Information
| Provider Information | |||||||||
| NPI: | 1447215751 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALL | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1140 E 3900 S | ||||||||
| Address2: | SUITE 390 | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841241228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017434700 | ||||||||
| FaxNumber: | 8017434705 | ||||||||
| Practice Location | |||||||||
| Address1: | 1140 E 3900 S | ||||||||
| Address2: | SUITE 390 | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841241228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017434700 | ||||||||
| FaxNumber: | 8017434705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 04/21/2010 | ||||||||
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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 | 207VM0101X | 346663-1205 | UT | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | 207V00000X | 346663-1205 | UT | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 200134020A | 05 | OK | MEDICAID | 1447215751 | 05 | WY | MEDICAID | 31835716 | 05 | CO | MEDICAID |