Provider Demographics
NPI:1720374648
Name:BANKS, SEAN C
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:C
Last Name:BANKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SEAN
Other - Middle Name:C
Other - Last Name:BANKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-416-7619
Mailing Address - Fax:850-416-7753
Practice Address - Street 1:3010 15TH AVE S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5240
Practice Address - Country:US
Practice Address - Phone:406-454-2171
Practice Address - Fax:303-306-7753
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT36048207R00000X
VA0102204833207R00000X, 208M00000X
FLOS11339207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003779100Medicaid
FLOS11339OtherFLORIDA MEDICAL LICENSE
MTM011008029Medicare PIN
FLOS11339OtherFLORIDA MEDICAL LICENSE