Individual provider · NPI-1

John Charles Ballantyne, M.D.

Family Medicine · Columbia, MO

NPI number1487068813
StatusActive
Last updated in NPPESJun 13, 2014

Details

NPI
1487068813
Entity type
Individual (NPI-1)
Name
John Charles Ballantyne
Credential
M.D.
Sex
Male
Sole proprietor
Yes
Enumeration date
Jun 13, 2014
Last updated
Jun 13, 2014

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine2014017807MOYes

Practice location

1 Hospital Dr
Ma303, Dc032.00
Columbia, MO 65212-1000

Phone 573-884-7733 · Fax 573-882-6228

Mailing address

1 Hospital Dr
Ma303, Dc032.00
Columbia, MO 65212-1000

Phone 573-884-7733 · Fax 573-882-6228

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