Provider Demographics
NPI:1679654867
Name:MCBANE, AMANDA CAROL (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:CAROL
Last Name:MCBANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:27961 US HIGHWAY 98
Mailing Address - Street 2:SUITE 20
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-4702
Mailing Address - Country:US
Mailing Address - Phone:251-621-6520
Mailing Address - Fax:251-621-6521
Practice Address - Street 1:27961 US HIGHWAY 98
Practice Address - Street 2:SUITE 20
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4702
Practice Address - Country:US
Practice Address - Phone:251-621-6520
Practice Address - Fax:251-621-6521
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 105944207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01524881Medicaid
AL51544031OtherBCBS - 1504 SPRINGHILL
AL009912557Medicaid
MS01524881Medicaid
AL51544031OtherBCBS - 1504 SPRINGHILL