Provider Demographics
NPI:1538183116
Name:BANMAN, EDWARD JACOB (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:JACOB
Last Name:BANMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3555 LOMA VISTA RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3161
Mailing Address - Country:US
Mailing Address - Phone:805-653-0303
Mailing Address - Fax:805-653-5761
Practice Address - Street 1:3555 LOMA VISTA RD
Practice Address - Street 2:SUITE 110
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3161
Practice Address - Country:US
Practice Address - Phone:805-653-0303
Practice Address - Fax:805-653-5761
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA25989207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA25989EMedicare ID - Type UnspecifiedTELEGRAPH LOCATION
CAWA25989DMedicare ID - Type UnspecifiedLOMA VISTA LOCATION
CAA24657Medicare UPIN