Provider Demographics
NPI:1295824431
Name:CHARLES L BATSON PA-FAMILY
Entity Type:Organization
Organization Name:CHARLES L BATSON PA-FAMILY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BATSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-621-1056
Mailing Address - Street 1:PO BOX 915257
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32791-5257
Mailing Address - Country:US
Mailing Address - Phone:407-331-7010
Mailing Address - Fax:407-331-8071
Practice Address - Street 1:450 W SR 434
Practice Address - Street 2:#2010
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5187
Practice Address - Country:US
Practice Address - Phone:407-331-7010
Practice Address - Fax:407-331-8071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46662207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL621985OtherAETNA
FL59981OtherBCBS
FL59981OtherBCBS
FL621985OtherAETNA