Healthcare Provider Details

I. General information

NPI: 1760484927
Provider Name (Legal Business Name): JOHN W. BATTY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 DR MARTIN LUTHER KING JR AVE NE SUITE 210
ALBUQUERQUE NM
87102-3661
US

IV. Provider business mailing address

715 DR MARTIN LUTHER KING JR AVE NE SUITE 210
ALBUQUERQUE NM
87102-3661
US

V. Phone/Fax

Practice location:
  • Phone: 505-248-1800
  • Fax: 505-338-3611
Mailing address:
  • Phone: 505-248-1800
  • Fax: 505-338-3611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number84-145
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number84-145
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: