| Keith M Banton Md Pa | |
|
3230 E 15th St Unit B Panama City FL 32405-7423 | |
| (850) 763-4700 | |
| (850) 763-4999 |
| Full Name | Keith M Banton Md Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 3230 E 15th St, Panama City, Florida |
| Authorized Official Name and Position | Keith M Banton (PRESIDENT) |
| Authorized Official Contact | 8507634700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Keith M Banton Md Pa 3230 E 15th St Unit B Panama City FL 32405-7423 Ph: (850) 763-4700 | Keith M Banton Md Pa 3230 E 15th St Unit B Panama City FL 32405-7423 Ph: (850) 763-4700 |
| NPI Number | 1891887600 |
|---|---|
| Provider Enumeration Date | 09/29/2006 |
| Last Update Date | 04/28/2014 |
| Medicare PECOS PAC ID | 0941302574 |
|---|---|
| Medicare Enrollment ID | O20070228000061 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891887600 | NPI | - | NPPES |
| 265799600 | Medicaid | FL | |
| 13636 | Other | FL | BCBS OF FLORIDA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ME85024 (Florida) | Primary |
| Provider Name | Keith M Banton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205896636 PECOS PAC ID: 9739168188 Enrollment ID: I20040719000528 |
| Provider Name | Destinee Bertia Blei |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346734324 PECOS PAC ID: 9032455126 Enrollment ID: I20190110001451 |
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