Provider Demographics
NPI:1235180696
Name:BATISTE, COREY GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:GREGORY
Last Name:BATISTE
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 1:20542 N LAKE PLEASANT RD
Mailing Address - Street 2:STE 105
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-9749
Mailing Address - Country:US
Mailing Address - Phone:602-753-2700
Mailing Address - Fax:480-359-4424
Practice Address - Street 1:505 NE 87TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-4801
Practice Address - Country:US
Practice Address - Phone:360-514-7210
Practice Address - Fax:360-514-7211
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428632207W00000X
AZ37045207W00000X
WAMD60771806207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ222665Medicaid