Organization
SPECIALTY CLINICS OF ST ANNE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTIN BAUTISTA M.D. (MD)
(580) 338-8700
Entity
Organization
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
207Q00000X
Family Medicine Physician
26523
OK
207R00000X
Internal Medicine Physician
Primary
19756
OK
207R00000X
Internal Medicine Physician
19772
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100748490A
—
OK
Enumeration date
07/19/2006
Last updated
02/03/2015
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