Individual
DR. JASON DAVID BANISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
225 MEDICAL CENTER DR, STE 205, PADUCAH, KY 42003-7907
(270) 441-4462
(270) 441-4461
Mailing address
PO BOX 636961, CINCINNATI, OH 45263-6961
(513) 981-5130
(513) 981-5015
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
32967
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64027147
—
KY
Enumeration date
11/07/2006
Last updated
11/25/2014
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