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General NPI Number Information
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NPI Number | 1235318023
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Entity Type | Organization
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Legal Business Name | CHANDI BANKSTON, D.O.
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Dates
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Enumeration Date | 10/29/2007
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Last Update Date | 10/30/2007
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Provider Practice Location Address
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Address Line | 1315 12TH ST
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City | ALAMOGORDO
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State | NM
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Zip | 88310-5810
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Country | US
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Telephone | 505-437-5716
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Fax | 505-437-5733
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Provider Business Mailing Address
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Address Line | 1315 12TH ST
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City | ALAMOGORDO
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State | NM
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Zip | 88310-5810
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Country | US
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Telephone | 505-437-5716
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Fax | 505-437-5733
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHANDI BANKSTON
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Credential | D.O.
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Telephone | 505-437-5716
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A-1146-00
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License Number State | NM
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