Bautista, Joel O
Bautista, Joel O is an individual health care provider with primary practice located at 151 Victoria Commons Blvd Suite 105, Deland FL 32724-7700. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Bautista, Joel O can be contacted via phone (386) 943-7175.Contact Information
Primary practice address
151 Victoria Commons Blvd Suite 105
Deland FL 32724-7700
Phone: (386) 943-7175
Fax: (386) 734-8825
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | ME 102468 | Florida |
Profile Details
| NPI number | 1700878253 |
|---|---|
| LBN Legal business name | Bautista, Joel O |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 19th, 2005 |
| Last updated | Oct 6th, 2010 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1700878253 | NPPES |
| Missouri | MEDICAID | 203716105 | |
| Missouri | Other | 29232 | |
| Missouri | Other | 020019367 |
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