MARCIANO DAVID BAUTISTA

GLENNALLEN, AK
NPI1114078995
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207Q00000X Family Medicine
(Licence: AK  4535)
Additional Taxonomies207Q00000X Family Medicine
(Licence: CO  35579)
207Q00000X Family Medicine
(Licence: MI  5101013320)
Enumeration Date2007-01-16
Last Update Date2009-03-31
Business Address
-- MARCIANO DAVID BAUTISTA D.O.
MILE 187.5 GLENN HWY
GLENNALLEN, AK 99588-0589
Phone number: 907-822-3203
Mailing Address
-- MARCIANO DAVID BAUTISTA D.O.
PO BOX 5 MILE 187.5 GLENN HWY
GLENNALLEN, AK 99588-0589
Phone number: 907-822-3203