Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 01046423A | IN |
N | 207ND0101X | MOHS-Micrographic Surgeon | 01046423A | IN |
N | 207ND0900X | Dermatopathologist | 01046423A | IN |
N | 207NP0225X | Pediatric Dermatologist | 01046423A | IN |
N | 207NS0135X | Procedural Dermatology | 01046423A | IN |
NPI | 1245211937 |
---|---|
Provider Name | Duane Edward Banet |
First Address | New Albany, IN 47150-2427 |
Second Address | New Albany, IN 47150-2427 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 10/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G55603 | (02) | IN |