Provider Demographics
NPI:1457317539
Name:O'BANION, DENNIS DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:DAVID
Last Name:O'BANION
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:919 HIDDEN RDG
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3813
Mailing Address - Country:US
Mailing Address - Phone:469-282-2711
Mailing Address - Fax:469-282-0996
Practice Address - Street 1:1920 GALLERIA OAKS DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-4619
Practice Address - Country:US
Practice Address - Phone:903-792-6114
Practice Address - Fax:903-792-7876
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6586208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX020022812OtherTRAVELERS MEDICARE
TX102179202Medicaid
TX81G983OtherTX BLUE CROSS
TX102179205Medicaid
AR126280000OtherQUALCHOICE
LA1557714OtherLOUISIANA MEDICAID
AR110840001Medicaid
AR81808OtherARK BLUE CROSS
TX770069401OtherBREASTCARE
OK100082820AOtherOKLA MEDICAID
TX770069401OtherBREASTCARE
LA1557714OtherLOUISIANA MEDICAID