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NPI Code Detail

MEDICARE: DR. RIM BANNOUT MD

MEDICARE: DR. RIM BANNOUT MD
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
1207RC0000XCardiovascular Disease PhysicianK4364TX

General Provider Information

NPI Number : 1841246113
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RIM BANNOUT MD
Provider Business Mailing Address
First Line : 1500 S MAIN ST
Second Line : CARDIOLOGY
City : FORT WORTH
State : TX
Zip : 76104-4917
Country : US
Telephone Number : 817-927-1395
Fax Number :
Provider Business Practice Location Address
First Line : 1500 S MAIN ST
Second Line : CARDIOLOGY
City : FORT WORTH
State : TX
Zip : 76104-4917
Country : US
Telephone Number : 817-927-1395
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2006
Last Update Date : 10/29/2012

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