Individual
DR. CRAIG M. BANULL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
1106 DRUID RD S, SUITE 302, CLEARWATER, FL 33756-3846
(727) 441-3711
Mailing address
PO BOX 917368, ORLANDO, FL 32891-0001
(727) 793-9300
(727) 793-0052
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
ME92112
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16163
BLUE CROSS BLUE SHIELD
FL
05
—
272753600
—
FL
01
—
P00358083
RR MEDICARE
FL
Enumeration date
06/02/2006
Last updated
08/18/2011
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