Provider Demographics
NPI:1457361800
Name:BANGSTON, JOHN FRANCIS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FRANCIS
Last Name:BANGSTON
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:11671 JOLLYVILLE RD
Mailing Address - Street 2:STE 203
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4141
Mailing Address - Country:US
Mailing Address - Phone:512-246-9632
Mailing Address - Fax:512-338-5155
Practice Address - Street 1:11671 JOLLYVILLE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4139
Practice Address - Country:US
Practice Address - Phone:512-338-5150
Practice Address - Fax:512-338-5155
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2017-03-28
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Provider Licenses
StateLicense IDTaxonomies
TXK7990207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8262M0Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
TX00073RMedicare ID - Type UnspecifiedGROUP NUMBER
TXG60533Medicare UPIN