Healthcare Provider Details

I. General information

NPI: 1720374648
Provider Name (Legal Business Name): SEAN CONSTANTINE BANKS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SEAN C BANKS DO

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 15TH AVE S
GREAT FALLS MT
59405-5240
US

IV. Provider business mailing address

PO BOX 2699
PENSACOLA FL
32513-2699
US

V. Phone/Fax

Practice location:
  • Phone: 406-454-2171
  • Fax: 303-306-7753
Mailing address:
  • Phone: 850-416-7619
  • Fax: 850-416-7753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0102204833
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0102204833
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36048
License Number StateMT
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS11339
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: