Provider Demographics
NPI:1831369966
Name:BATEMAN, JOHN BRIAN (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BRIAN
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:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:541-778-8617
Mailing Address - Fax:
Practice Address - Street 1:348 E 4500 S STE 220
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-8524
Practice Address - Country:US
Practice Address - Phone:801-577-7055
Practice Address - Fax:888-717-7578
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088177207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine