Organization
DAN F BAUTISTA MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAN BAUTISTA M.D. (OWNER)
(937) 754-4580
Entity
Organization
Contact information
Practice address
1840 COMMERCE CENTER BLVD, FAIRBORN, OH 45324-6337
(937) 754-4580
(937) 754-4575
Mailing address
1840 COMMERCE CENTER BLVD, FAIRBORN, OH 45324-6337
(937) 754-4580
(937) 754-4575
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35073682B
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2080233
—
OH
05
—
2871969
—
OH
Enumeration date
04/20/2007
Last updated
09/20/2023
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