Individual
SEAN PATRICK ALONZA BANNISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
745 NW FEDERAL HWY, STUART, FL 34994-1016
(772) 247-7545
(772) 264-3272
Mailing address
745 NW FEDERAL HWY, STUART, FL 34994-1016
(772) 247-7545
(772) 264-3272
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
PA9105846
FL
363AS0400X
Surgical Physician Assistant
Primary
PA9105846
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003293800
—
FL
01
—
Y06TH
BLUE CROSS BLUE SHIELD
FL
Enumeration date
02/07/2007
Last updated
09/04/2023
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