Provider Demographics
NPI:1659098846
Name:BANET, DAVID JOSHUA
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JOSHUA
Last Name:BANET
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 CREIGHTON RD APT O2
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-4641
Mailing Address - Country:US
Mailing Address - Phone:847-668-0453
Mailing Address - Fax:
Practice Address - Street 1:7000 COBBLE CRK
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8638
Practice Address - Country:US
Practice Address - Phone:847-668-0453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA423210156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist