Provider Demographics
NPI:1790855708
Name:BANNAN, BARBARA JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:JEAN
Last Name:BANNAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 E BEACH ST
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-4809
Mailing Address - Country:US
Mailing Address - Phone:831-728-0222
Mailing Address - Fax:831-707-2777
Practice Address - Street 1:204 E BEACH ST
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-4809
Practice Address - Country:US
Practice Address - Phone:831-728-0222
Practice Address - Fax:831-707-2777
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68640207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70530FMedicaid
CAE90118Medicare UPIN
CAZZZ15686ZMedicare ID - Type UnspecifiedCOUNTY OF MONTEREY GROUP