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NPI Code Detail

MEDICARE: DR. KEITH B BANTON M.D.

MEDICARE: DR. KEITH B BANTON 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
1207Q00000XFamily Medicine PhysicianME0085024FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
213636OTHERFLBCBS OF FLORIDA
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205896636
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEITH B BANTON M.D.
Provider Business Mailing Address
First Line : 3230 E 15TH ST
Second Line : UNIT B
City : PANAMA CITY
State : FL
Zip : 32405-7423
Country : US
Telephone Number : 850-763-4700
Fax Number : 850-763-4999
Provider Business Practice Location Address
First Line : 1937 HARRISON AVE
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-4543
Country : US
Telephone Number : 850-763-4700
Fax Number : 850-763-4999
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2006
Last Update Date : 02/22/2019

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