Provider Demographics
NPI:1356477681
Name:BANNING, DOUGLAS R (DO)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:R
Last Name:BANNING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:27371 S 4410 RD
Mailing Address - Street 2:
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301-7953
Mailing Address - Country:US
Mailing Address - Phone:918-256-4800
Mailing Address - Fax:918-256-4597
Practice Address - Street 1:27371 S 4410 RD
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-7953
Practice Address - Country:US
Practice Address - Phone:918-256-4800
Practice Address - Fax:918-256-4597
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK3104207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200522063Medicare PIN
OKF59163Medicare UPIN