MEDICARE: DR. JOHN LEE BANKSTON III M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080N0001X	Neonatal-Perinatal Medicine Physician	ME44216	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093778318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN LEE BANKSTON III M.D

Provider Business Mailing Address
First Line	:	215 GRAND AVE
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33133-4841
Country	:	US
Telephone Number	:	305-441-7179
Fax Number	:	305-448-7134

Provider Business Practice Location Address
First Line	:	13001 SOUTHERN BLVD
Second Line	:	PALM'S WEST HOSPITAL NICU
City	:	LOXAHATCHEE
State	:	FL
Zip	:	33470-2413
Country	:	US
Telephone Number	:	561-840-6220
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2006
Last Update Date	:	03/17/2018

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