Provider Demographics
NPI:1851538912
Name:PAUL EBANKS, DPM, PA
Entity Type:Organization
Organization Name:PAUL EBANKS, DPM, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:EBANKS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:863-382-1570
Mailing Address - Street 1:4233 SUN N LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-2158
Mailing Address - Country:US
Mailing Address - Phone:863-382-1570
Mailing Address - Fax:863-471-2101
Practice Address - Street 1:4233 SUN N LAKE BLVD
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-2158
Practice Address - Country:US
Practice Address - Phone:863-382-1570
Practice Address - Fax:863-471-0908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3117213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL118950300Medicaid