Individual
MONICO PETER BANEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
620 SKYLINE DR, JACKSON, TN 38301-3923
(731) 660-8759
Mailing address
1804 HIGHWAY 45 BYP, SUITE 604, JACKSON, TN 38305-4436
(731) 660-8759
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
35303
TN
208M00000X
Hospitalist Physician
Primary
27436
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3889132
—
TN
01
—
4070560
BCBS
—
01
—
P00077531
RR MEDICARE
—
Enumeration date
03/02/2006
Last updated
08/15/2022
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