MEDICARE: DR. EVELYN R. 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	207ZC0500X	Cytopathology Physician	0101042456	VA
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	0101042456	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740288877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EVELYN R. BANKS M.D.

Provider Business Mailing Address
First Line	:	1563 FOXLEIGH CT
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-1229
Country	:	US
Telephone Number	:	314-580-4207
Fax Number	:

Provider Business Practice Location Address
First Line	:	1563 FOXLEIGH CT
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-1229
Country	:	US
Telephone Number	:	314-580-4207
Fax Number	:

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	11/03/2016

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