Provider Demographics
NPI:1235122334
Name:EUBANKS, DAVID A (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:EUBANKS
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 1:132 CAYUGA RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-1942
Mailing Address - Country:US
Mailing Address - Phone:716-204-9711
Mailing Address - Fax:716-204-9717
Practice Address - Street 1:132 CAYUGA RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-1942
Practice Address - Country:US
Practice Address - Phone:716-204-9711
Practice Address - Fax:716-204-9717
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194962207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01500018Medicaid
NY01500018Medicaid
A15095Medicare UPIN