MEDICARE: PAUL A EBANKS DPM

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	213E00000X	Podiatrist	PO 3117	FL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982681219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL A EBANKS DPM

Provider Business Mailing Address
First Line	:	4233 SUN N LAKE BLVD
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33872-2158
Country	:	US
Telephone Number	:	863-382-1570
Fax Number	:	863-471-2101

Provider Business Practice Location Address
First Line	:	4233 SUN N LAKE BLVD
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33872-2158
Country	:	US
Telephone Number	:	863-382-1570
Fax Number	:	863-471-0908

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

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	11/06/2023

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