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General NPI Number Information
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NPI Number | 1730131038
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Entity Type | Individual
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Provider Name | WADE M BATEMAN MD
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Gender | Male
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 09/11/2012
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Provider Practice Location Address
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Address Line | 12080 W. MCMILLAN RD
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City | BOISE
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State | ID
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Zip | 83713
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Country | US
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Telephone | 208-375-4955
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Fax | 208-375-5568
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Provider Business Mailing Address
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Address Line | 190 E BANNOCK ST
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City | BOISE
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State | ID
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Zip | 83712
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Country | US
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Telephone | 208-375-4955
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Fax | 208-375-5568
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M5537
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License Number State | ID
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