Healthcare Provider Details

I. General information

NPI: 1023397833
Provider Name (Legal Business Name): ALAN BANKHEAD PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2011
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 SAN DIMAS ST STE B100
BAKERSFIELD CA
93301-2285
US

IV. Provider business mailing address

PO BOX 1139
BAKERSFIELD CA
93302-1139
US

V. Phone/Fax

Practice location:
  • Phone: 661-326-0088
  • Fax:
Mailing address:
  • Phone: 661-371-2796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number21727
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: