Individual
DR. MARIO BAUTISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 VETERANS DR, JACKSON, OH 45640-9586
(740) 395-8090
(740) 395-8197
Mailing address
272 HOSPITAL RD STE 6, CHILLICOTHE, OH 45601-9031
(740) 779-4275
(740) 779-4257
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
2004-0547
NM
208000000X
Pediatrics Physician
Primary
35.089012
OH
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
2004-0547
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10016535
LOVELACE HEALTH/SALUD
NM
01
—
201047701
PRESBYTERIAN HEALTH/SALUD
NM
05
—
2711211
—
OH
01
—
885808
AHCCCS
AZ
05
—
99238071
—
NM
01
—
NM009R63
BC/BS
NM
01
—
P00137209
RAILROAD MEDICARE
—
01
—
PROVP11655
MOLINA
NM
Enumeration date
01/05/2006
Last updated
11/25/2020
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