Provider Demographics
NPI:1164154969
Name:BATTESE, JEFF M
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:M
Last Name:BATTESE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 S ESCALARA ST
Mailing Address - Street 2:
Mailing Address - City:GLOBE
Mailing Address - State:AZ
Mailing Address - Zip Code:85501-2587
Mailing Address - Country:US
Mailing Address - Phone:617-407-4000
Mailing Address - Fax:
Practice Address - Street 1:145 S ESCALARA ST
Practice Address - Street 2:
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-2587
Practice Address - Country:US
Practice Address - Phone:617-407-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-29
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty