| Dan F Bautista Md Llc | |
|
1840 Commerce Center Blvd Fairborn OH 45324-6337 | |
| (937) 754-4580 | |
| (937) 754-4575 |
| Full Name | Dan F Bautista Md Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1840 Commerce Center Blvd, Fairborn, Ohio |
| Authorized Official Name and Position | Dan Bautista (OWNER) |
| Authorized Official Contact | 9377544580 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dan F Bautista Md Llc 1840 Commerce Center Blvd Fairborn OH 45324-6337 Ph: (937) 754-4580 | Dan F Bautista Md Llc 1840 Commerce Center Blvd Fairborn OH 45324-6337 Ph: (937) 754-4580 |
| NPI Number | 1295953933 |
|---|---|
| Provider Enumeration Date | 04/20/2007 |
| Last Update Date | 09/20/2023 |
| Medicare PECOS PAC ID | 0244264091 |
|---|---|
| Medicare Enrollment ID | O20050921000987 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295953933 | NPI | - | NPPES |
| 2080233 | Medicaid | OH | |
| 2871969 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 35073682B (Ohio) | Primary |
| Provider Name | Dan F Bautista |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629006903 PECOS PAC ID: 1052345808 Enrollment ID: I20100528000000 |
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