Provider Demographics
NPI:1942318753
Name:BATTLE, CLINTON C JR (MD)
Entity Type:Individual
Prefix:
First Name:CLINTON
Middle Name:C
Last Name:BATTLE
Suffix:JR
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 171618
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76003-1618
Mailing Address - Country:US
Mailing Address - Phone:817-921-6541
Mailing Address - Fax:888-456-4198
Practice Address - Street 1:817 BAKER ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104
Practice Address - Country:US
Practice Address - Phone:817-921-6541
Practice Address - Fax:888-456-4198
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1368207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7168854OtherCIGNA
TX033011001Medicaid
TX751857683OtherTRICARE
TX751857683OtherTRICARE
TX033011001Medicaid
TXC13262Medicare UPIN