Provider Demographics
NPI:1952339533
Name:BANKS, RAYNANDO LAMOUR SR (MD)
Entity Type:Individual
Prefix:
First Name:RAYNANDO
Middle Name:LAMOUR
Last Name:BANKS
Suffix:SR
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 1:3870 CONVENTION ST
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-3803
Mailing Address - Country:US
Mailing Address - Phone:225-387-7858
Mailing Address - Fax:225-381-6980
Practice Address - Street 1:3870 CONVENTION ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806
Practice Address - Country:US
Practice Address - Phone:225-387-7858
Practice Address - Fax:225-381-6980
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08979R174400000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1924245Medicaid
LA1924245Medicaid