Healthcare Provider Details

I. General information

NPI: 1649220849
Provider Name (Legal Business Name): GARRY M BANKS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8290 UNIVERSITY AVE NE STE 200
FRIDLEY MN
55432-1876
US

IV. Provider business mailing address

8290 UNIVERSITY AVE NE STE 200
FRIDLEY MN
55432-1876
US

V. Phone/Fax

Practice location:
  • Phone: 763-786-9543
  • Fax: 763-786-3320
Mailing address:
  • Phone: 763-786-9543
  • Fax: 763-786-3320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number33956
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: