Provider Demographics
NPI:1114941770
Name:BANICK, PAUL DAVID (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:DAVID
Last Name:BANICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11484
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37939-1484
Mailing Address - Country:US
Mailing Address - Phone:865-342-7859
Mailing Address - Fax:865-558-4363
Practice Address - Street 1:311 S WEISGARBER RD STE D
Practice Address - Street 2:SUITE D
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-7504
Practice Address - Country:US
Practice Address - Phone:865-342-7859
Practice Address - Fax:865-558-4363
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29453207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNF73357Medicare UPIN
TN3815111Medicare ID - Type Unspecified