Individual
JERRY LEE BANGERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7356 NORTH LA CHOLLA BLVD., TUCSON, AZ 85741
(520) 575-1007
(214) 596-7422
Mailing address
PO BOX 844777, DALLAS, TX 75284-4777
(888) 344-1160
(972) 331-3148
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
11270
AZ
207ND0900X
Dermatopathology Physician
11270
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
263062
—
AZ
Enumeration date
04/25/2006
Last updated
11/25/2013
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