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General NPI Number Information
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NPI Number | 1144621053
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Entity Type | Individual
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Provider Name | LORA BANKS PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/10/2014
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Last Update Date | 09/10/2014
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Provider Practice Location Address
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Address Line | 2105 E SOUTH BLVD
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City | MONTGOMERY
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State | AL
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Zip | 36116-2409
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Country | US
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Telephone | 334-213-6255
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Fax |
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Provider Business Mailing Address
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Address Line | 14050 NW 14TH ST STE 190
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City | SUNRISE
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State | FL
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Zip | 33323-2851
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Country | US
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Telephone | 800-424-3672
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | TA1776
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License Number State | AL
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