Provider Demographics
NPI:1518153097
Name:BATEMAN, KIM ALAN (MD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:ALAN
Last Name:BATEMAN
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 1:111 N 460 E
Mailing Address - Street 2:
Mailing Address - City:EPHRAIM
Mailing Address - State:UT
Mailing Address - Zip Code:84627-1215
Mailing Address - Country:US
Mailing Address - Phone:435-283-4730
Mailing Address - Fax:801-892-0160
Practice Address - Street 1:111 N 460 E
Practice Address - Street 2:
Practice Address - City:EPHRAIM
Practice Address - State:UT
Practice Address - Zip Code:84627-1215
Practice Address - Country:US
Practice Address - Phone:435-283-4730
Practice Address - Fax:801-892-0160
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT158124-8905207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine