Provider Demographics
NPI:1902964737
Name:BANKS, MARK GORDON (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:GORDON
Last Name:BANKS
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:624 QUAKER LN
Mailing Address - Street 2:SUITE 207 C
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-3832
Mailing Address - Country:US
Mailing Address - Phone:336-883-2500
Mailing Address - Fax:336-883-9728
Practice Address - Street 1:404 WESTWOOD AVE
Practice Address - Street 2:STE.205
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4315
Practice Address - Country:US
Practice Address - Phone:336-884-1400
Practice Address - Fax:336-884-1402
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2011-08-04
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Provider Licenses
StateLicense IDTaxonomies
NC1032117363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2759137Medicare PIN