Individual
JON MICHAEL BANAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3680 BROADWAY, FORT MYERS, FL 33901-8005
(239) 936-2316
(239) 931-6365
Mailing address
3660 BROADWAY, FORT MYERS, FL 33901-8005
(239) 936-2316
(239) 931-6365
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
036100431
IL
2085R0202X
Diagnostic Radiology Physician
Primary
OS10560
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001495200
—
FL
05
—
036100431
—
IL
01
—
P00801888
RAILROAD MEDICARE
FL
Enumeration date
09/14/2005
Last updated
02/10/2011
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