Provider Demographics
NPI:1891896908
Name:BANKER, DIPESH (MD)
Entity Type:Individual
Prefix:
First Name:DIPESH
Middle Name:
Last Name:BANKER
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 1:840 S RANCHO DR
Mailing Address - Street 2:SUITE 4 #342
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-3837
Mailing Address - Country:US
Mailing Address - Phone:702-202-3431
Mailing Address - Fax:702-202-3455
Practice Address - Street 1:2031 MCDANIEL ST
Practice Address - Street 2:SUITE #210
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-6303
Practice Address - Country:US
Practice Address - Phone:702-633-0207
Practice Address - Fax:702-633-5099
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11996207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1891896908Medicaid
NVV106001Medicare PIN
NV1891896908Medicaid