Organization
CHAIM BANJO MD PHD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHAIM BANJO MD PHD (OWNER)
(972) 686-7947
Entity
Organization
Contact information
Practice address
718 W MOORE AVE, 101, TERRELL, TX 75160
(972) 551-1900
Mailing address
718 W MOORE AVE, 101, TERRELL, TX 75160
(972) 551-1900
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
G4442
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
109453402
—
TX
01
—
85A011
RENDERING PROVIDER
TX
Enumeration date
09/27/2006
Last updated
03/08/2011
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