MEDICARE: DR. KEVIN PATRICK BANKS M.D.

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	207U00000X	Nuclear Medicine Physician	M3887	TX
2	2085R0202X	Diagnostic Radiology Physician	041588	CT
3	2085R0202X	Diagnostic Radiology Physician	M3887	TX

General Provider Information

NPI Number	:	1356331656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN PATRICK BANKS M.D.

Provider Business Mailing Address
First Line	:	3551 ROGER BROOKE DR
Second Line	:	QUALITY SERVICES / 7TH FLOOR, ATTN: MCHE-ZQQ
City	:	JBSA FT SAM HOUSTON
State	:	TX
Zip	:	78234-4505
Country	:	US
Telephone Number	:	210-310-8777
Fax Number	:

Provider Business Practice Location Address
First Line	:	SAN ANTONIO MILITARY MEDICAL CENTER
Second Line	:	3551 ROGER BROOKE DR
City	:	FT SAM HOUSTON
State	:	TX
Zip	:	78261
Country	:	US
Telephone Number	:	210-916-1906
Fax Number	:

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

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	09/20/2019

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