MEDICARE: DR. WARREN R BANACH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	11333	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144202284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WARREN R BANACH M.D.

Provider Business Mailing Address
First Line	:	101 E BRUNSON ST
Second Line	:	SUITE 310
City	:	ENTERPRISE
State	:	AL
Zip	:	36330-2526
Country	:	US
Telephone Number	:	334-393-0737
Fax Number	:	334-393-0914

Provider Business Practice Location Address
First Line	:	101 E BRUNSON ST
Second Line	:	SUITE 310
City	:	ENTERPRISE
State	:	AL
Zip	:	36330-2526
Country	:	US
Telephone Number	:	334-393-0737
Fax Number	:	334-393-0914

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	10/28/2011

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