MEDICARE: RANDY GENE BANKS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA 3145	FL

General Provider Information

NPI Number	:	1144248824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDY GENE BANKS PA-C

Provider Business Mailing Address
First Line	:	801 YORK ST
Second Line	:
City	:	MANITOWOC
State	:	WI
Zip	:	54220-4630
Country	:	US
Telephone Number	:	920-663-9008
Fax Number	:	920-684-1439

Provider Business Practice Location Address
First Line	:	1200 GULF BREEZE PKWY STE A
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32561-4851
Country	:	US
Telephone Number	:	800-243-7546
Fax Number	:	850-484-8223

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	02/19/2025

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