Organization
NORTHPARK ORTHOPAEDICS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES JACK BANTA II M.D. (PHYSICIAN)
(214) 987-3434
Entity
Organization
Contact information
Practice address
8220 WALNUT HILL LN, SUITE 608, DALLAS, TX 75231-4427
(214) 987-3434
(214) 987-3799
Mailing address
8220 WALNUT HILL LN, SUITE 608, DALLAS, TX 75231-4427
(214) 987-3434
(214) 987-3799
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
J0438
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CZ0012
RAILROAD MEDICARE
TX
Enumeration date
04/23/2007
Last updated
10/29/2007
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