Provider Demographics
NPI:1497707723
Name:BANKS, TRACEY A (MD)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:A
Last Name:BANKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6609 VIRGINIA PARKWAY
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-5513
Mailing Address - Country:US
Mailing Address - Phone:972-542-8884
Mailing Address - Fax:214-544-9400
Practice Address - Street 1:6609 VIRGINIA PARKWAY
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-5513
Practice Address - Country:US
Practice Address - Phone:972-542-8884
Practice Address - Fax:214-544-9400
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7992207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A6840Medicare ID - Type Unspecified
TXG34258Medicare UPIN