Provider Demographics
NPI:1205923588
Name:BATEMAN, DEWITT (MD)
Entity type:Individual
Prefix:
First Name:DEWITT
Middle Name:
Last Name:BATEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WOMANS WAY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-5100
Mailing Address - Country:US
Mailing Address - Phone:225-293-2523
Mailing Address - Fax:225-293-1807
Practice Address - Street 1:8325 KELWOOD AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4804
Practice Address - Country:US
Practice Address - Phone:225-929-7600
Practice Address - Fax:225-930-7524
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021212207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA050067567OtherRR MEDICARE PROVIDER NUMB
LA1535184Medicaid
LA721077264BAOtherHUMANA PROVIDER NUMBER
LAG04066OtherSTERLING PROVIDER NUMBER
LA050067567OtherRR MEDICARE PROVIDER NUMB
LAG04066OtherSTERLING PROVIDER NUMBER