Provider Demographics
NPI:1760410542
Name:BANWART, JON CHRISTOPHER (MD)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:CHRISTOPHER
Last Name:BANWART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 MEDICAL CENTER PKWY STE 310
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3214
Mailing Address - Country:US
Mailing Address - Phone:479-757-4048
Mailing Address - Fax:479-757-2992
Practice Address - Street 1:2900 MEDICAL CENTER PKWY STE 310
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3214
Practice Address - Country:US
Practice Address - Phone:479-757-4048
Practice Address - Fax:479-757-2992
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-26856207X00000X
OK29046207X00000X
MO107602207X00000X
ARE-19533207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204725600Medicaid
OKOKA105515OtherNOVITAS
KS10033710VMedicaid
KS100332710DMedicaid
MO963345141Medicare PIN
OKOKA105515OtherNOVITAS
MO204725600Medicaid