Healthcare Provider Details

I. General information

NPI: 1487607180
Provider Name (Legal Business Name): BANU E SYMINGTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 COLLEGE DR
ROCK SPRINGS WY
82901-5863
US

IV. Provider business mailing address

PO BOX 1359
ROCK SPRINGS WY
82902-1359
US

V. Phone/Fax

Practice location:
  • Phone: 307-382-2234
  • Fax: 307-382-2302
Mailing address:
  • Phone: 307-382-2234
  • Fax: 307-382-2302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberM9184
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number5606A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: