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Organization
KIM LISA BANGO MD PA
Active
Organization
KIM LISA BANGO MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIM LISA BANGO M.D. (OWNER)
(432) 263-0500
Entity
Organization
Contact information
Practice address
1608 W FM 700, SUITE D, BIG SPRING, TX 79720-4105
(432) 263-0500
(432) 263-0501
Mailing address
1608 W FM 700, SUITE D, BIG SPRING, TX 79720-4105
(432) 263-0500
(432) 263-0501
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M3462
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
182593701
—
TX
Enumeration date
06/12/2006
Last updated
04/13/2010
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