Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | R3796 | TX |
N | 207ND0900X | Dermatopathologist | R3796 | TX |
NPI | 1780828863 |
---|---|
Provider Name | Dr. Justin Peter Bandino |
First Address | Jbsa Lackland, TX 78236-5638 |
Second Address | Lackland Afb, TX 78236-5638 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2009 |
Last Update Date | 04/05/2020 |