Provider Demographics
NPI:1972540755
Name:BANKS, LAURA T (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:T
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 1:337 EL DORAD ST
Mailing Address - Street 2:SUITE B3
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940
Mailing Address - Country:US
Mailing Address - Phone:831-372-7400
Mailing Address - Fax:
Practice Address - Street 1:337 EL DORADO ST
Practice Address - Street 2:SUITE B3
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4647
Practice Address - Country:US
Practice Address - Phone:831-372-7400
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78682174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH39487Medicare UPIN