Individual
LAWRENCE ESTEL BANTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1906 FAIRVIEW AVE, SUITE 200, CALDWELL, ID 83605-5407
(208) 459-4667
(208) 442-6520
Mailing address
PO BOX 277976, ATLANTA, GA 30384-7976
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
M-5243
ID
Other
Enumeration date
01/03/2006
Last updated
02/10/2022
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