Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 224P00000X | MS |
NPI | 1285848846 |
---|---|
Provider Name | Douglas Santrell Banks |
First Address | Ridgeland, MS 39157-4358 |
Second Address | Ridgeland, MS 39157-4358 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 10/02/2014 |