Individual
DR. DWARAKNADH R BANALA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
620 S LAKE ST, SUITE #6, LEESBURG, FL 34748-6059
(352) 365-0099
(352) 315-0578
Mailing address
3016 PALERMO CT, MOUNT DORA, FL 32757-6527
(352) 383-8209
(352) 383-8209
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME80590
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2729423 00
—
FL
Enumeration date
05/31/2006
Last updated
01/11/2011
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