=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982681219
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL A EBANKS DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2005
-----------------------------------------------------
Last Update Date | 11/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4233 SUN N LAKE BLVD
-----------------------------------------------------
City | SEBRING
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33872-2158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-382-1570
-----------------------------------------------------
Fax | 863-471-0908
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4233 SUN N LAKE BLVD
-----------------------------------------------------
City | SEBRING
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33872-2158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-382-1570
-----------------------------------------------------
Fax | 863-471-2101
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | PO 3117
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------