Provider Demographics
NPI:1518192343
Name:BATLLE, LUIS JOSE (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:JOSE
Last Name:BATLLE
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:PO BOX 17328
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-0328
Mailing Address - Country:US
Mailing Address - Phone:862-452-5630
Mailing Address - Fax:727-216-0374
Practice Address - Street 1:2250 DREW ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-3305
Practice Address - Country:US
Practice Address - Phone:727-797-7463
Practice Address - Fax:727-216-0374
Is Sole Proprietor?:No
Enumeration Date:2009-05-22
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT195184208600000X
FLTRN15996208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHX839ZMedicare PIN