Provider Demographics
NPI:1538720149
Name:ABIMBOLA M. BANJO MD P.A
Entity type:Organization
Organization Name:ABIMBOLA M. BANJO MD P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M D
Authorized Official - Prefix:DR
Authorized Official - First Name:ABIMBOLA
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BANJO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-416-7012
Mailing Address - Street 1:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:TX
Mailing Address - Zip Code:78064-0146
Mailing Address - Country:US
Mailing Address - Phone:830-569-2440
Mailing Address - Fax:830-281-4300
Practice Address - Street 1:130 S WATER ST
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:TX
Practice Address - Zip Code:78064-4044
Practice Address - Country:US
Practice Address - Phone:830-569-2440
Practice Address - Fax:830-218-4300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care