Provider Demographics
NPI:1447223904
Name:BATAYOLA, CHARLES E (DO)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:BATAYOLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 GAGE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9532
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-627-2983
Practice Address - Street 1:560 GAGE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-9531
Practice Address - Country:US
Practice Address - Phone:509-942-3286
Practice Address - Fax:509-628-1354
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001867207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1118124Medicaid
WA172404OtherL & I
WA172404OtherL & I
WA1118124Medicaid