Organization
TERRILL M BANER M.D., LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA BROWN (OFFICE MANAGER)
(309) 762-1488
Entity
Organization
Contact information
Practice address
608 35TH AVE, MOLINE, IL 61265-6145
(309) 762-1488
(309) 792-9745
Mailing address
608 35TH AVE, MOLINE, IL 61265-6145
(309) 762-1488
(309) 792-9745
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08100333
BLUE CROSS BLUE SHIELD
IL
01
—
IL0101
UHC OF THE RIVER VALLEY
IL
Enumeration date
10/24/2007
Last updated
10/24/2007
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