Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 6203 | LA |
NPI | 1336359744 |
---|---|
Provider Name | Dr. Andrew R Banker |
First Address | Bossier City, LA 71111-2167 |
Second Address | Bossier City, LA 71111-2167 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 09/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
09336 | (05) | LA |
1093360 | (05) | LA |