Healthcare Provider Details

I. General information

NPI: 1093804460
Provider Name (Legal Business Name): HEATHER S BANKS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5495 ARAPAHOE AVE
BOULDER CO
80303-1200
US

IV. Provider business mailing address

6750 BUGLE CT
BOULDER CO
80301-3869
US

V. Phone/Fax

Practice location:
  • Phone: 720-848-9200
  • Fax:
Mailing address:
  • Phone: 505-353-2591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD24027
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0038923
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: