Provider Demographics
NPI:1346210267
Name:BATEMAN, LUCINDA (MD)
Entity Type:Individual
Prefix:
First Name:LUCINDA
Middle Name:
Last Name:BATEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 E SOUTH TEMPLE
Mailing Address - Street 2:STE 408
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1571
Mailing Address - Country:US
Mailing Address - Phone:801-359-7400
Mailing Address - Fax:801-359-7404
Practice Address - Street 1:1002 E SOUTH TEMPLE
Practice Address - Street 2:STE 408
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1571
Practice Address - Country:US
Practice Address - Phone:801-359-7400
Practice Address - Fax:801-359-7404
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT178153 1205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT0491073OtherUNITED HEALTHCARE
UT0491073OtherUNITED HEALTHCARE
UT00012303Medicare PIN