Provider Demographics
NPI:1043212616
Name:BANISTER, PAMELA K (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:K
Last Name:BANISTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:K
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 840026
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0026
Mailing Address - Country:US
Mailing Address - Phone:806-212-6965
Mailing Address - Fax:806-212-6278
Practice Address - Street 1:3501 S SONCY RD STE 150
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6426
Practice Address - Country:US
Practice Address - Phone:806-212-6353
Practice Address - Fax:806-212-0558
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12878207Q00000X
TXK7991207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111959607Medicaid
TX1D7229OtherMEDICARE
TX111959605Medicaid