Provider Demographics
NPI:1750359956
Name:BAUTISTA, RAMON EDMUNDO (MD)
Entity type:Individual
Prefix:DR
First Name:RAMON
Middle Name:EDMUNDO
Last Name:BAUTISTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP PROVIDER ENROLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:580 W 8TH ST
Practice Address - Street 2:UFJP NEUROLOGY
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6533
Practice Address - Country:US
Practice Address - Phone:904-244-3961
Practice Address - Fax:904-244-3425
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME824952084N0400X
GA0379512084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000877016AMedicaid
FL2587718-00Medicaid
GA000877016CMedicaid
FL49942ZMedicare PIN
FLH14454Medicare UPIN
FL2587718-00Medicaid
FL130022507Medicare PIN
GA13BBDFGMedicare PIN