Individual
ELISEO A. BAUTISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5855 BREMO RD, SUITE 506, RICHMOND, VA 23226-1926
(804) 285-3225
(804) 285-0360
Mailing address
5855 BREMO RD, SUITE 506, RICHMOND, VA 23226-1926
(804) 285-3225
(804) 285-0360
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
0101051604
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002940C63
SECURE HORIZONS
VA
01
—
010024536
VA PREMIER
VA
05
—
010024536
—
VA
01
—
230046
SOUTHERN HEALTH
VA
01
—
269001
BC/BS
VA
01
—
30961
OPTIMA
VA
01
—
4270015
AETNA
VA
01
—
44645
CARENET
VA
01
—
541267736
CIGNA
VA
01
—
C06695
GROUP PTAN
VA
Enumeration date
05/18/2006
Last updated
03/12/2012
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