Individual
DR. BRUCE C BANNING JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1 ARH LANE, LOW MOOR, VA 24457
(540) 862-6287
Mailing address
PO BOX 13808, ROANOKE, VA 24037-3808
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
0101042066
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7212526
—
VA
Enumeration date
06/26/2006
Last updated
07/08/2007
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