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General NPI Number Information
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NPI Number | 1265575062
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Entity Type | Organization
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Legal Business Name | RAYMOND P. BAKOTIC, DO, PLLC
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 01/30/2008
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Provider Practice Location Address
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Address Line | 1925 W ORANGE GROVE RD SUITE 209
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City | TUCSON
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State | AZ
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Zip | 85704-1143
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Country | US
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Telephone | 520-469-7351
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Fax | 520-469-7355
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Provider Business Mailing Address
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Address Line | 1925 W ORANGE GROVE RD SUITE 209
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City | TUCSON
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State | AZ
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Zip | 85704-1143
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Country | US
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Telephone | 520-469-7351
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Fax | 520-469-7355
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | RAYMOND P BAKOTIC
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Credential | DO
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Telephone | 520-469-7351
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2712
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License Number State | AZ
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