Provider Demographics
NPI:1205066461
Name:BANKS, BRENT STEPHEN (DPM)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:STEPHEN
Last Name:BANKS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1307 8TH AVE STE 407
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4107
Mailing Address - Country:US
Mailing Address - Phone:817-776-5333
Mailing Address - Fax:817-380-2428
Practice Address - Street 1:1307 8TH AVE STE 407
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4107
Practice Address - Country:US
Practice Address - Phone:817-776-5333
Practice Address - Fax:817-380-2428
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1922213ES0103X
IL016005419213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery