Healthcare Provider Details

I. General information

NPI: 1063882330
Provider Name (Legal Business Name): WILLIAM M BANNISTER, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2015
Last Update Date: 09/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2407 S HUGHES ST
AMARILLO TX
79109-2307
US

IV. Provider business mailing address

2407 S HUGHES ST
AMARILLO TX
79109-2307
US

V. Phone/Fax

Practice location:
  • Phone: 214-315-6432
  • Fax: 214-317-4667
Mailing address:
  • Phone: 214-315-6432
  • Fax: 214-317-4667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM BANNISTER
Title or Position: OWNER
Credential: MD
Phone: 214-315-6432