MEDICARE: DR. CHRISTINE KO BANG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0001X	Radiation Oncology Physician	ME123077	FL
2	2085R0001X	Radiation Oncology Physician	0101242870	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	382565	OTHER	FL	AVMED
2	150CE	OTHER	FL	BC/BS
3	4885776	OTHER	FL	AETNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699824946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINE KO BANG M.D.

Provider Business Mailing Address
First Line	:	7015 A C SKINNER PKWY
Second Line	:	SUITE 1
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6932
Country	:	US
Telephone Number	:	904-363-2113
Fax Number	:	904-363-2606

Provider Business Practice Location Address
First Line	:	2370 MARKET DR
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-4326
Country	:	US
Telephone Number	:	904-264-6201
Fax Number	:	904-264-6858

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	07/29/2015

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