Individual
MR. JACK P BANDURA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5959 PARK AVE, MEMPHIS, TN 38119-5200
(901) 765-2057
(901) 765-2077
Mailing address
PO BOX 1000, MEMPHIS, TN 38148-0001
(901) 523-7019
(901) 259-4236
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
9908
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3154736
BLUE CROSS
TN
05
—
3859780
—
TN
Enumeration date
09/14/2006
Last updated
07/08/2007
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