Individual
MARY CHRISTINE BANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
901 7TH AVE, FORT WORTH, TX 76104-2722
(682) 885-1050
(682) 885-7572
Mailing address
PO BOX 99371, FORT WORTH, TX 76199-0371
(682) 885-1855
(682) 885-7347
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
K2217
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00U87Z
BCBSTX GRP PIN
TX
05
—
043860807
—
TX
01
—
043860808
CSHCN
TX
01
—
10011835
AMERIGROUP PIN
TX
01
—
124029
SUPERIOR PIN
TX
01
—
1727210
FIRSTHEALTH PIN
TX
01
—
1750369203
GRP NPI NUMBER
—
01
—
413461
PHCS PIN
TX
01
—
85381B
BCBSTX IND PIN
TX
Enumeration date
10/26/2006
Last updated
05/06/2013
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