Organization
LIZA DE OLAZO BANAAG, M. D., P. A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LIZA DE OLAZO BANAAG MD (OWNER)
(832) 646-5492
Entity
Organization
Contact information
Practice address
965 J K AVENT DR, SUITE 100-A, GRENADA, MS 38901-5045
(662) 227-7446
Mailing address
PO BOX 2329, GRENADA, MS 38902-2329
(832) 646-5492
Taxonomy
Speciality
Code
Description
License number
State
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
Primary
19748
MS
Other
Enumeration date
02/26/2007
Last updated
01/25/2008
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