Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 1354 | TX |
Y | 222Z00000X | Podiatrist | 1354 | TX |
NPI | 1003047275 |
---|---|
Provider Name | Jared B Bateman |
First Address | Fort Worth, TX 76104-4250 |
Second Address | Fort Worth, TX 76104-4250 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2009 |
Last Update Date | 05/08/2009 |