Healthcare Provider Details

I. General information

NPI: 1912921875
Provider Name (Legal Business Name): DON GARY BATTEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: D. GARY BATTEN D.O.

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 NORTH FAIRWAY DR
LAKE ARROWHEAD CA
92352
US

IV. Provider business mailing address

PO BOX 537
BLUE JAY CA
92317-0537
US

V. Phone/Fax

Practice location:
  • Phone: 909-336-6919
  • Fax:
Mailing address:
  • Phone: 909-336-6919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A6687
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: