Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | ME44216 | FL |
NPI | 1093778318 |
---|---|
Provider Name | Dr. John Lee Bankston III |
First Address | Coral Gables, FL 33133-4841 |
Second Address | Loxahatchee, FL 33470-2413 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
062713500 | (05) | FL |
D57267 | (02) |