Provider Demographics
NPI:1326485426
Name:BANKS, BRANDON CODY (MD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:CODY
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 1:210 LAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-8548
Mailing Address - Country:US
Mailing Address - Phone:318-323-6405
Mailing Address - Fax:318-807-0205
Practice Address - Street 1:210 LAYTON AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-8548
Practice Address - Country:US
Practice Address - Phone:318-323-6405
Practice Address - Fax:318-807-0205
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA323842207LP2900X
TN52354207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ037475Medicaid