Provider Demographics
NPI:1366732059
Name:DAVID W. BANK M.D. INC.
Entity type:Organization
Organization Name:DAVID W. BANK M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BANK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-225-4000
Mailing Address - Street 1:1221 COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-2800
Mailing Address - Country:US
Mailing Address - Phone:580-225-4000
Mailing Address - Fax:580-243-3408
Practice Address - Street 1:1221 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-2800
Practice Address - Country:US
Practice Address - Phone:580-225-4000
Practice Address - Fax:580-243-3408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9686261Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKD34365Medicare UPIN