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:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 ST MICHAEL DR.
Mailing Address - Street 2:STE 307
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503
Mailing Address - Country:US
Mailing Address - Phone:903-614-5356
Mailing Address - Fax:469-282-0996
Practice Address - Street 1:1801 GALLERIA OAKS DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-4616
Practice Address - Country:US
Practice Address - Phone:903-614-4200
Practice Address - Fax:903-614-5399
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6586208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100082820AOtherOKLA MEDICAID
AR126280000OtherQUALCHOICE
TX102179207Medicaid
AR81808OtherARK BLUE CROSS
TX770069401OtherBREASTCARE
LA1557714OtherLOUISIANA MEDICAID
TX81G983OtherTX BLUE CROSS
TX020022812OtherTRAVELERS MEDICARE
AR110840001Medicaid
OK100082820AOtherOKLA MEDICAID
TX770069401OtherBREASTCARE
LA1557714OtherLOUISIANA MEDICAID