Individual
TRAVIS BRUCE BANTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
331083
LA
2085R0202X
Diagnostic Radiology Physician
91576
GA
2085R0202X
Diagnostic Radiology Physician
T-3287
MS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/28/2017
Last updated
10/20/2022
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