Provider Demographics
NPI:1760410542
Name:BANWART, JON CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:CHRISTOPHER
Last Name:BANWART
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 2546
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-2546
Mailing Address - Country:US
Mailing Address - Phone:620-783-4441
Mailing Address - Fax:620-783-4090
Practice Address - Street 1:444 FOUR STATES DR SUITE 1
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:KS
Practice Address - Zip Code:66739-4325
Practice Address - Country:US
Practice Address - Phone:620-783-4441
Practice Address - Fax:620-783-4444
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-26856207X00000X
OK29046207X00000X
MO107602207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS10033710VMedicaid
MO204725600Medicaid
KS100332710DMedicaid
OKOKA105515OtherNOVITAS
MO963345141Medicare PIN
OKOKA105515OtherNOVITAS
MO204725600Medicaid