Provider Demographics
NPI:1629176813
Name:BAUTSCH, BILL T (MD)
Entity Type:Individual
Prefix:
First Name:BILL
Middle Name:T
Last Name:BAUTSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-4290
Mailing Address - Country:US
Mailing Address - Phone:850-571-5844
Mailing Address - Fax:850-571-5845
Practice Address - Street 1:1702 OHIO AVE
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-4290
Practice Address - Country:US
Practice Address - Phone:850-571-5844
Practice Address - Fax:850-571-5845
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050626207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002867800OtherNFMG MCD#
FL03781OtherBLUE CROSS
FLDQ287AOtherNFMG MEDICARE#
FL000X0OtherBCBS NFMG
FLB90A9OtherBCBS UC
FL000X0OtherBCBS NFMG