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Individual

MARTIN BAUTISTA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
350 NE 12TH ST, GUYMON, OK 73942-3624
(580) 338-8700
(580) 338-8600
Mailing address
350 NE 12TH ST, GUYMON, OK 73942-3624
(580) 338-8700
(580) 338-8600

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
19756
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100025580A
OK
Enumeration date
07/19/2006
Last updated
06/13/2012
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