Provider Demographics
NPI:1700131125
Name:BAUTISTA, JOSEF EDRIK KEITH ABIOG (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEF
Middle Name:EDRIK KEITH ABIOG
Last Name:BAUTISTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1840 E RAY RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-8720
Mailing Address - Country:US
Mailing Address - Phone:553-970-1978
Mailing Address - Fax:800-272-6512
Practice Address - Street 1:2707 COLBY AVE STE 718
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3564
Practice Address - Country:US
Practice Address - Phone:425-339-5413
Practice Address - Fax:425-339-4213
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-23
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD15199207RN0300X
WAMD61032416207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2157737Medicaid