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General NPI Number Information
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NPI Number | 1326613936
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Entity Type | Individual
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Provider Name | MARK BANNON DO
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Gender | Male
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Dates
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Enumeration Date | 05/25/2021
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Last Update Date | 07/16/2024
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Provider Practice Location Address
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Address Line | 1600 MEDICAL CENTER DR
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City | HUNTINGTON
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State | WV
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Zip | 25701-3656
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Country | US
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Telephone | 304-691-1095
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 E DOWNING ST
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City | TAHLEQUAH
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State | OK
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Zip | 74464-3324
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Country | US
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Telephone | 918-456-0641
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 7692
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 7692
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 7692
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License Number State | OK
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Taxonomy #4
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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