Provider Demographics
NPI:1275553612
Name:BANKS, ALAN M (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:M
Last Name:BANKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1055 N 500 W
Mailing Address - Street 2:CREDENTIALING DEPARTMENT
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:801-354-8225
Mailing Address - Fax:801-429-8180
Practice Address - Street 1:1184 E 80 N
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2906
Practice Address - Country:US
Practice Address - Phone:801-763-3885
Practice Address - Fax:801-763-3887
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT162904-1205207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107006253103OtherIHC
UT36235OtherDMBA
UT870281028000Medicaid
UT870281028AB2OtherEMIA
UT215833OtherALTIUS
UT09-00528OtherUNITED HEALTHCARE
UT79374OtherPEHP
UTP00122330OtherPALMETTO
UT215833OtherALTIUS