Bandura, Jack P

Bandura, Jack P is an individual health care provider with primary practice located at 5959 Park Ave , Memphis TN 38119-5200. He recently has only one registered license in Allopathic & Osteopathic Physicians / Cardiovascular Disease, which is considered as his primary health care specialty. Bandura, Jack P can be contacted via phone (901) 765-2057.

Contact Information

Primary practice address
5959 Park Ave Memphis TN 38119-5200
Phone: (901) 765-2057
Fax: (901) 765-2077
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X 9908 Tennessee

Profile Details

NPI number 1174628010
LBN Legal business name Bandura, Jack P
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 14th, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1174628010 NPPES
Tennessee MEDICAID 3859780
Tennessee Other 3154736

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