Organization
R.L. BAUTISTA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROGELIO L BAUTISTA M.D. (PRESIDENT)
(660) 263-2650
Entity
Organization
Contact information
Practice address
1145 S MORLEY ST, MOBERLY, MO 65270-1948
(660) 263-2650
(660) 263-9010
Mailing address
1145 S MORLEY ST, MOBERLY, MO 65270-1948
(660) 263-2650
(660) 263-9010
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
33051
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1636
ANTHEM BCBS
MO
01
—
CT0809
TRAVELERS RR MEDICARE
MO
Enumeration date
03/30/2007
Last updated
11/21/2007
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