Provider Demographics
NPI:1699966325
Name:BRUCE BANIAS MD LLC
Entity type:Organization
Organization Name:BRUCE BANIAS MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:BLAND
Authorized Official - Last Name:BANIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:932-293-5200
Mailing Address - Street 1:3075 GOVERNORS PLACE BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-1323
Mailing Address - Country:US
Mailing Address - Phone:937-293-5200
Mailing Address - Fax:937-424-5925
Practice Address - Street 1:3075 GOVERNORS PLACE BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-1323
Practice Address - Country:US
Practice Address - Phone:937-293-5200
Practice Address - Fax:937-424-5925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052271207V00000X
OH3562520C207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty