Individual
RODOLFO BAUTISTA GANZON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1500 MATTHEWS TOWNSHIP PKWY, MATTHEWS, NC 28105-4656
(704) 384-9740
(704) 384-9565
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-9740
(704) 384-9565
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
200100871
NC
208M00000X
Hospitalist Physician
Primary
200100871
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110236348
RR MEDICARE
NC
01
—
12994
BC BS NC
NC
05
—
8912994
—
NC
05
—
N00878
—
SC
Enumeration date
07/19/2006
Last updated
10/25/2020
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