Provider Demographics
NPI:1366496267
Name:BATLEY, JERRY O JR (MD)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:O
Last Name:BATLEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7125 ORCHARD LAKE RD
Mailing Address - Street 2:STE 316
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3629
Mailing Address - Country:US
Mailing Address - Phone:866-607-2308
Mailing Address - Fax:248-855-5455
Practice Address - Street 1:34 MOUNTAIN BLVD STE 203
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-2640
Practice Address - Country:US
Practice Address - Phone:668-607-2308
Practice Address - Fax:248-855-5455
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101231512208600000X
NMMD2015-0624208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM33883025Medicaid
VA007313004Medicaid
NM33883025Medicaid
NM432354YNGGMedicare Oscar/Certification