LAWRENCE ESTEL BANTA

CALDWELL, ID
NPI1568440295
Professional NameLARRY ESTEL BANTA
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy2084P0800X Psychiatry & Neurology, Psychiatry
(Licence: ID  M-5243)
Enumeration Date2006-01-03
Last Update Date2022-02-10
Business Address
-- LAWRENCE ESTEL BANTA M.D.
1906 FAIRVIEW AVE SUITE 200
CALDWELL, ID 83605-5407
Phone number: 208-459-4667
Mailing Address
-- LAWRENCE ESTEL BANTA M.D.
PO BOX 277976
ATLANTA, GA 30384-7976
Phone number:
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