Individual
ROGELIO L BAUTISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1201 N RUTHERFORD ST, MACON, MO 63552-2020
(660) 385-8900
(660) 385-8708
Mailing address
1201 N RUTHERFORD ST, MACON, MO 63552-2020
(660) 385-8900
(660) 385-8708
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
33051
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
022155151
TRAVELERS RR MEDICARE
MO
05
—
200148807
—
MO
01
—
20245
ANTHEM BCBS
MO
Enumeration date
08/19/2005
Last updated
09/24/2012
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