Provider Demographics
NPI:1699765974
Name:BANEZ, ELOISA YU (MD)
Entity type:Individual
Prefix:DR
First Name:ELOISA
Middle Name:YU
Last Name:BANEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 STADIUM DR
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TX
Mailing Address - Zip Code:76380
Mailing Address - Country:US
Mailing Address - Phone:940-889-5572
Mailing Address - Fax:940-889-3337
Practice Address - Street 1:200 STADIUM DRIVE
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TX
Practice Address - Zip Code:76380
Practice Address - Country:US
Practice Address - Phone:940-889-5572
Practice Address - Fax:940-889-3337
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0347207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBA000H65LOtherBLUE CROSS
TX130795107Medicaid
TX110034454OtherRAILROAD MEDICARE PIN
TX130795102Medicaid
TX130795107Medicaid
TXC13126Medicare UPIN