Basic Information
| Provider Information | |||||||||
| NPI: | 1053587683 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BANE | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3131 S. DIXIE DRIVE | ||||||||
| Address2: | SUITE 535 | ||||||||
| City: | MORAINE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454392223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372930247 | ||||||||
| FaxNumber: | 9372930960 | ||||||||
| Practice Location | |||||||||
| Address1: | 2222 PHILADELPHIA DRIVE | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454061891 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372781624 | ||||||||
| FaxNumber: | 9375674163 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2008 | ||||||||
| LastUpdateDate: | 10/06/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MT188693 | PA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 35.127062 | OH | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.