Provider Demographics
NPI:1205846995
Name:STEVEN G. BANDER, D.O., P.A.
Entity Type:Organization
Organization Name:STEVEN G. BANDER, D.O., P.A.
Other - Org Name:BANDER FAMILY MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:BANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-442-4888
Mailing Address - Street 1:791 S HIGHWAY 78
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-4004
Mailing Address - Country:US
Mailing Address - Phone:972-442-4888
Mailing Address - Fax:972-442-4970
Practice Address - Street 1:791 S HIGHWAY 78
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098
Practice Address - Country:US
Practice Address - Phone:972-442-4888
Practice Address - Fax:972-442-4970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3129302F00000X, 302R00000X, 305R00000X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114033703Medicaid
TX114033703Medicaid
TX00344RMedicare PIN