Healthcare Provider Details

I. General information

NPI: 1922184647
Provider Name (Legal Business Name): SCOTT N BATEMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 10/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 W DOW ST
SHERIDAN WY
82801-3829
US

IV. Provider business mailing address

330 W DOW ST
SHERIDAN WY
82801-3829
US

V. Phone/Fax

Practice location:
  • Phone: 307-672-0290
  • Fax: 307-672-0884
Mailing address:
  • Phone: 307-672-0290
  • Fax: 307-672-0884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number5710A
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number5710A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: