Individual
DR. MODESON-SAMUEL BANEZ FERRER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2560 N SHADELAND AVE, STE A, INDIANAPOLIS, IN 46219-1705
(866) 463-7284
(610) 271-4245
Mailing address
14275 MIDWAY RD, SUITE 400, ADDISON, TX 75001-3614
(610) 271-4245
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
01070026A
IN
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
207ZP0102X
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201046610
—
IN
Enumeration date
11/29/2006
Last updated
10/25/2018
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