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General NPI Number Information
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NPI Number | 1760624704
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Entity Type | Organization
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Legal Business Name | GARRY G BANKS MD PA
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Dates
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Enumeration Date | 04/06/2009
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Last Update Date | 04/06/2009
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Provider Practice Location Address
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Address Line | 552 TWIN CITIES BLVD SUITE A
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City | NICEVILLE
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State | FL
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Zip | 32578-1055
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Country | US
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Telephone | 850-678-7676
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Fax | 850-678-8240
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Provider Business Mailing Address
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Address Line | 552 TWIN CITIES BLVD SUITE A
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City | NICEVILLE
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State | FL
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Zip | 32578-1055
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Country | US
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Telephone | 850-678-7676
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Fax | 850-678-8240
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Authorized Official
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Title or Position | PRESIDENT
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Name | GARRY G BANKS
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Credential | MD PA
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Telephone | 850-678-7676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME0062947
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License Number State | FL
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