Provider Demographics
NPI:1801838693
Name:CATES, BANKS RALEIGH III (MD)
Entity type:Individual
Prefix:
First Name:BANKS
Middle Name:RALEIGH
Last Name:CATES
Suffix:III
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 1:1 INDEPENDENCE PT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:864-797-6044
Mailing Address - Fax:
Practice Address - Street 1:1409 W GEORGIA RD
Practice Address - Street 2:SUITE D
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-6419
Practice Address - Country:US
Practice Address - Phone:864-454-6540
Practice Address - Fax:864-454-6545
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9142207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC110248003OtherRR MEDICARE
SC576007863064OtherBCBS OF SC
SC110128502OtherRR MEDICARE
SC4586510OtherAETNA
SC091421Medicaid
SC110248003OtherRR MEDICARE
SC4586510OtherAETNA
SCB916437951Medicare PIN