Provider Demographics
NPI:1164489845
Name:BATENHORST, TODD JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:JAMES
Last Name:BATENHORST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3266
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32085-3266
Mailing Address - Country:US
Mailing Address - Phone:904-518-1299
Mailing Address - Fax:
Practice Address - Street 1:130 HEALTH PARK BLVD.
Practice Address - Street 2:
Practice Address - City:ST. AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5776
Practice Address - Country:US
Practice Address - Phone:904-826-3469
Practice Address - Fax:904-808-4608
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82769207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL080176505OtherPALMETTO GBA RAILROAD MED
FL26923500Medicaid
FL26923500Medicaid
FLH47216Medicare UPIN