Provider Demographics
NPI:1962415299
Name:BANNOR, PHILIP A (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:A
Last Name:BANNOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6106 SHALLOWFORD RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1615
Mailing Address - Country:US
Mailing Address - Phone:423-760-8700
Mailing Address - Fax:423-576-0870
Practice Address - Street 1:6106 SHALLOWFORD RD
Practice Address - Street 2:SUITE 108
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1615
Practice Address - Country:US
Practice Address - Phone:423-760-8700
Practice Address - Fax:423-760-8703
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2014-04-09
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Provider Licenses
StateLicense IDTaxonomies
TN35052207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H36747Medicare UPIN