Rogelio L Bautista, M.D.
Individual provider Active NPI Surgery Physician · Macon, MO
NPI 1164414660 · NPPES record last updated Sep 24, 2012
Key facts
- NPI
- 1164414660
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgery Physician 208600000X
- License
- 33051 (MO)
- Practice address
- 1201 N Rutherford St
Macon, MO 63552-2020 - Phone
- (660) 385-8900
- Fax
- (660) 385-8708
- NPI assigned
- Aug 19, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33051 | MO | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| R.L. Bautista, Inc. | Surgery | Current | Accepting new patients |
| Moberly Medical Clinics Inc | Past | Accepting new patients | |
| Midwest Heart and Vein Center, LLC | Past | Accepting new patients | |
| Moberly Medical Clinics Inc | Past | Accepting new patients |
Locations
1145 S Morley St
Moberly, MO 65270
Phone (660) 263-2650
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 33051 | MO | Yes |
Addresses
Primary practice location
1201 N Rutherford St
Macon, MO 63552-2020
Mailing address
1201 N Rutherford St
Macon, MO 63552-2020
Phone (660) 385-8900
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200148807 | Medicaid | MO | |
| 20245 | Other | MO | ANTHEM BCBS |
| 022155151 | Other | MO | TRAVELERS RR MEDICARE |
Other providers in Macon, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 24, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.