Individual
DR. DAN F BAUTISTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
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
01
—
000000259761
BLUE CROSS BLUE SHIELD
OH
01
—
0109918
UNITED HEALTHCARE
OH
05
—
2080233
—
OH
05
—
2871969
—
OH
01
—
2897281
CIGNA
OH
01
—
300107
AMERIGROUP PIN
OH
01
—
310809436DAB
SUMMIT PIN
OH
01
—
32004929300
BWC PIN
OH
01
—
320049293027
CARESOURCE
OH
01
—
5405631
AETNA
OH
01
—
D7368201
HUMANA
OH
01
—
P12036623
MULTIPLAN
OH
Enumeration date
06/28/2006
Last updated
09/19/2011
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