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General NPI Number Information
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NPI Number | 1437576972
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Entity Type | Individual
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Provider Name | ERIC BAUTISTA M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/22/2014
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 1620 BROADWAY STE 100A
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City | SEATTLE
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State | WA
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Zip | 98122-2560
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Country | US
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Telephone | 888-663-6331
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Fax | 415-252-7176
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Provider Business Mailing Address
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Address Line | 306 23RD AVE S STE 200
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City | SEATTLE
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State | WA
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Zip | 98144-2371
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 61233955
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License Number State | WA
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