Individual
DR. BRUCE DOUGLAS BANWART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
12415
SD
2080P0203X
Pediatric Critical Care Medicine Physician
2015008610
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100421570A
—
KS
05
—
205855109
—
MO
Enumeration date
05/05/2006
Last updated
03/24/2021
Update your record
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