Provider Demographics
NPI:1053378653
Name:BANKS, GEORGE EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:EDWARD
Last Name:BANKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 6TH AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1928
Mailing Address - Country:US
Mailing Address - Phone:941-748-0747
Mailing Address - Fax:727-866-0786
Practice Address - Street 1:410 6TH AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1928
Practice Address - Country:US
Practice Address - Phone:941-748-0747
Practice Address - Fax:727-866-0786
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0034295207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01241OtherCIGNA
FL0705028OtherUNITED HEALTHCARE
FL592231298OtherHUMANA
FL62244OtherBLUE CROSS BLUE SHIELD
FL080234OtherAV-MED
FL039316900Medicaid
FL0667150OtherAETNA
FL080234OtherAV-MED
FL0667150OtherAETNA