Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | 32865 | TX |
NPI | 1225448889 |
---|---|
Provider Name | Dr. Jonathan David Bancroft |
First Address | San Antonio, TX 78258 |
Second Address | San Antonio, TX 78258-7336 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2014 |
Last Update Date | 24/07/2017 |