Individual
DR. JOHN A BANTLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10519 BRIGHTSTONE DR, MIDLOTHIAN, VA 23112-1570
(816) 807-8333
Mailing address
10519 BRIGHTSTONE DR, MIDLOTHIAN, VA 23112-1570
(816) 807-8333
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
0101240013
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010290881
—
VA
05
—
010291020
—
VA
05
—
010314453
—
VA
05
—
1962447532
—
VA
01
—
204990
BLUE SHIELD
VA
Enumeration date
06/18/2006
Last updated
01/12/2011
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