| NPI | 1386862654 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES JACK BANTA Physician 214-987-3434 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: TX J0438) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2007-10-29 |