Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 85865 | SC |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 25MA10394500 | NJ |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 85865 | SC |
NPI | 1518353648 |
---|---|
Provider Name | Mr. Dexter Kenneth Bateman |
First Address | Seneca, SC 29678 |
Second Address | Seneca, SC 29678 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2015 |
Last Update Date | 08/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PENDNIG | (05) | SC |