Healthcare Provider Details

I. General information

NPI: 1043212616
Provider Name (Legal Business Name): PAMELA K BANISTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAMELA K ROBINSON M.D.

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 S SONCY RD STE 150
AMARILLO TX
79119-6426
US

IV. Provider business mailing address

PO BOX 840026
DALLAS TX
75284-0026
US

V. Phone/Fax

Practice location:
  • Phone: 806-212-6353
  • Fax: 806-212-0558
Mailing address:
  • Phone: 806-212-6965
  • Fax: 806-212-6278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12878
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberK7991
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: