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NPI Code Detail

MEDICARE: ROGELIO L BAUTISTA M.D.

MEDICARE: ROGELIO L BAUTISTA M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery Physician33051MO

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3022155151OTHERMOTRAVELERS RR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
220245OTHERMOANTHEM BCBS

General Provider Information

NPI Number : 1164414660
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROGELIO L BAUTISTA M.D.
Provider Business Mailing Address
First Line : 1201 N RUTHERFORD ST
Second Line :
City : MACON
State : MO
Zip : 63552-2020
Country : US
Telephone Number : 660-385-8900
Fax Number : 660-385-8708
Provider Business Practice Location Address
First Line : 1201 N RUTHERFORD ST
Second Line :
City : MACON
State : MO
Zip : 63552-2020
Country : US
Telephone Number : 660-385-8900
Fax Number : 660-385-8708
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2005
Last Update Date : 09/24/2012

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Directions to “ ROGELIO L BAUTISTA M.D.” Practice Location

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