Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | M6311 | ID |
N | 207QS0010X | Family Doctor - Sports Medicine | M6311 | ID |
NPI | 1013961143 |
---|---|
Provider Name | Frank M Batcha |
First Address | Twin Falls, ID 83303-0587 |
Second Address | Hailey, ID 83333-8785 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2006 |
Last Update Date | 04/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003576300 | (05) | ID |
F62863 | (02) | |
P00721157 | MCRR (01) | ID |