Provider Demographics
NPI:1629010327
Name:BATTEN, CASEY GRANT (MD)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:GRANT
Last Name:BATTEN
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 1:2222 BANCROFT WAY
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94720-4300
Mailing Address - Country:US
Mailing Address - Phone:510-643-5808
Mailing Address - Fax:
Practice Address - Street 1:1011 RANCHO CONEJO BLVD
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91320-1718
Practice Address - Country:US
Practice Address - Phone:310-665-7200
Practice Address - Fax:888-835-0943
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD40312207P00000X
CAA96253207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3336942Medicaid
TN4115091OtherBCBS OF TENNESSEE
TN3336942Medicare ID - Type Unspecified
TNI49344Medicare UPIN