Organization
EXECUTIVE OUTCOMES PC
Active
Organization
EXECUTIVE OUTCOMES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MONICO P BANEZ MD (OWNER)
(731) 234-5717
Entity
Organization
Contact information
Practice address
379 HOSPITAL BLVD, JACKSON, TN 38305-2080
(731) 661-6330
Mailing address
PO BOX 11355, JACKSON, TN 38308-0122
(731) 234-5717
(423) 979-6333
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
06/25/2012
Last updated
08/14/2025
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