Provider Demographics
NPI:1326041617
Name:BANKS, MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:BANKS
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:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0853
Mailing Address - Country:US
Mailing Address - Phone:971-233-1999
Mailing Address - Fax:972-233-3666
Practice Address - Street 1:4144 N CENTRAL EXPY
Practice Address - Street 2:STE. 360
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204
Practice Address - Country:US
Practice Address - Phone:214-252-3511
Practice Address - Fax:214-826-6858
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6318207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8EH091OtherBCBS
TX106037805Medicaid
TX106037802Medicaid
TX106037802Medicaid
TX355747YK6UMedicare PIN
TXG47268Medicare UPIN
TX88X622Medicare PIN