MEDICARE: DR. SHANE FOREST BATIE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	U2784	TX
2	390200000X	Student in an Organized Health Care Education/Training Program		NM
3	2088P0231X	Pediatric Urology Physician	U2784	TX

General Provider Information

NPI Number	:	1518320449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANE FOREST BATIE MD

Provider Business Mailing Address
First Line	:	5323 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-7201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1935 MEDICAL DISTRICT DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-7701
Country	:	US
Telephone Number	:	623-523-4516
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2016
Last Update Date	:	11/09/2023

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