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Individual

MICHAEL GRIDLEY BANNON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
PO BOX 840853, DALLAS, TX 75284-0853
(214) 696-3540
(214) 696-1230
Mailing address
PO BOX 840853, DALLAS, TX 75284-0853
(972) 233-1999
(972) 233-3666

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
K5796
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
P000963D9
TX
Enumeration date
10/12/2005
Last updated
06/23/2020
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