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General NPI Number Information
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NPI Number | 1205896636
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Entity Type | Individual
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Provider Name | KEITH B BANTON M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/28/2006
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Last Update Date | 02/22/2019
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Provider Practice Location Address
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Address Line | 1937 HARRISON AVE
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City | PANAMA CITY
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State | FL
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Zip | 32405-4543
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Country | US
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Telephone | 850-763-4700
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Fax | 850-763-4999
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Provider Business Mailing Address
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Address Line | 3230 E 15TH ST UNIT B
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City | PANAMA CITY
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State | FL
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Zip | 32405-7423
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Country | US
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Telephone | 850-763-4700
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Fax | 850-763-4999
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME0085024
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License Number State | FL
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