Provider Demographics
NPI:1659661908
Name:BATTERTON, NICOLAS JOHN (MD)
Entity Type:Individual
Prefix:
First Name:NICOLAS
Middle Name:JOHN
Last Name:BATTERTON
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 1:6451 BRENTWOOD STAIR RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-3200
Mailing Address - Country:US
Mailing Address - Phone:972-249-0200
Mailing Address - Fax:972-249-0206
Practice Address - Street 1:1400 8TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4110
Practice Address - Country:US
Practice Address - Phone:972-249-0200
Practice Address - Fax:972-249-0206
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.207048207R00000X
TXR0359207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine