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Contact Information

MARIO BAUTISTA, MD
1000 VETERANS DR
JACKSON, OH45640-9586
 Phone: 740-395-8090
 Fax: 740-395-8197
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatrics

208000000X 37 Physician/Pediatric Medicine
 

Pediatric Emergency Medicine

2080P0204X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for MARIO BAUTISTA · (Male)

NPI Number 1619955192
Status Active
Credentials MD
Entity Individual
Enumeration date 01/05/2006
Last updated 11/25/2020 - About 6 years ago
Sole proprietor 1 No
Identifiers
  • NM License # 2004-0547
  • OH License # 35.089012
  • NM Medicaid 99238071
  • OH Medicaid 2711211
  • Other P00137209 RAILROAD MEDICARE
  • AZ Other 885808 AHCCCS
  • NM Other NM009R63 BC/BS
  • NM Other 10016535 LOVELACE HEALTH/SALUD
  • NM Other PROVP11655 MOLINA
  • NM Other 201047701 PRESBYTERIAN HEALTH/SALUD
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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