| Doctor Name: | BENJAMIN DAVID BANCHEK |
| NPI Number: | 1639424146 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | FNP |
| License Number: | 160115 |
| Business Practice Address: | 4500 Stuart Street, Room(s) #1-56 & 1-56a Moncrief Army Community Hospital Atm: Mcxl-pq (credenti Fort Jackson, SC - 292075720 |
| Business Phone Number: | 8037512789 |
| Business Fax Number: | |
| Mailing Address: | 4500 Stuart Street, Room(s) #1-56 & 1-56a, Moncrief Army Community Hospital Atm: Mcxl-pq (credenti FORT JACKSON |
| State: | SC |
| Postal Code: | 292075720 |
| Phone Number: | 8037512789 |
| Fax Number: | |
| NPI Enumeration Date: | 07/20/2012 |
| NPI Last Update Date: | 07/20/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 160115 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |