Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 25865 | DC |
NPI | 1336249655 |
---|---|
Provider Name | Dr. Willie Jasper Banks JR. |
First Address | Washington, DC 20422-0001 |
Second Address | Washington, DC 20422-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B94584 | (02) | DC |