Provider Demographics
NPI:1538195961
Name:BATEMAN, BLANE EDWARD (DO)
Entity type:Individual
Prefix:DR
First Name:BLANE
Middle Name:EDWARD
Last Name:BATEMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 LEIGHTON AVENUE
Mailing Address - Street 2:SUITE 506
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207
Mailing Address - Country:US
Mailing Address - Phone:256-238-0200
Mailing Address - Fax:256-236-8007
Practice Address - Street 1:901 LEIGHTON AVENUE
Practice Address - Street 2:SUITE 506
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207
Practice Address - Country:US
Practice Address - Phone:256-238-0200
Practice Address - Fax:256-236-8007
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD0325207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000088345Medicaid
AL000088345Medicaid
F08624Medicare UPIN