Provider Demographics
NPI:1245289529
Name:BANKS, RICHARD A JR (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:BANKS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:764 SACO LOWELL RD
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-3880
Mailing Address - Country:US
Mailing Address - Phone:864-855-5525
Mailing Address - Fax:864-855-5440
Practice Address - Street 1:741A WESSEL DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014
Practice Address - Country:US
Practice Address - Phone:513-829-2614
Practice Address - Fax:513-829-0177
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12294207Q00000X, 207P00000X
OH35133415207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC12294OtherSTATE LICENSE
SC122940Medicaid
1245289529OtherNPI
D612756089OtherMEDICARE ID
SC122940Medicaid