Individual
DR. MARK BANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1600 MEDICAL CENTER DR, HUNTINGTON, WV 25701-3656
(304) 691-1095
Mailing address
1400 E DOWNING ST, TAHLEQUAH, OK 74464-3324
(918) 456-0641
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
7692
OK
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
7692
OK
207RP1001X
Pulmonary Disease Physician
7692
OK
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/25/2021
Last updated
07/16/2024
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