Individual
JOEL O BAUTISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
151 VICTORIA COMMONS BLVD, SUITE 105, DELAND, FL 32724-7700
(386) 943-7175
(386) 734-8825
Mailing address
151 VICTORIA COMMONS BLVD, SUITE 105, DELAND, FL 32724-7700
(386) 943-7175
(386) 734-8825
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
ME 102468
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020019367
TRAVELERS MEDICARE
MO
05
—
203716105
—
MO
01
—
29232
ANTHEM BC/BS
MO
Enumeration date
08/19/2005
Last updated
10/06/2010
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