Individual
MARCIANO DAVID BAUTISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
MILE 187.5 GLENN HWY, GLENNALLEN, AK 99588-0589
(907) 822-3203
Mailing address
PO BOX 5, MILE 187.5 GLENN HWY, GLENNALLEN, AK 99588-0589
(907) 822-3203
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
35579
CO
207Q00000X
Family Medicine Physician
Primary
4535
AK
207Q00000X
Family Medicine Physician
5101013320
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1114078995
NPI
AK
01
—
P00673381
MEDICARE RAILROAD PTAN
AK
Enumeration date
01/16/2007
Last updated
03/31/2009
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