Individual
DR. CONSTANCIO M BAUTISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
161 WEST ST, MT WASHINGTON, KY 40047-7184
(502) 538-7425
Mailing address
PO BOX 130, MT WASHINGTON, KY 40047-0130
(502) 538-7425
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
16733
KY
Other
Enumeration date
01/20/2006
Last updated
07/08/2007
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