Individual
JUSTIN BANGHART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
21ST MDG 559 VINCENT ST, PAFB, CO 80914-1540
(719) 556-5898
Mailing address
559 VINVENT ST, PETERSON SPACE FORCE BASE, CO 80914
(719) 556-7019
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1164974
—
Other
Enumeration date
12/12/2019
Last updated
06/30/2022
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