Provider Demographics
NPI:1073527735
Name:BATTERTON, OWEN ALBERT (MD)
Entity Type:Individual
Prefix:
First Name:OWEN
Middle Name:ALBERT
Last Name:BATTERTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 N 1000 W
Mailing Address - Street 2:
Mailing Address - City:LINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47441-5282
Mailing Address - Country:US
Mailing Address - Phone:812-847-5212
Mailing Address - Fax:
Practice Address - Street 1:708 W MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:BLOOMFIELD
Practice Address - State:IN
Practice Address - Zip Code:47424-1179
Practice Address - Country:US
Practice Address - Phone:812-847-4481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030118A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100055360AMedicaid
IN100055360AMedicaid
059720Medicare ID - Type Unspecified