Basic Information
Provider Information | |||||||||
NPI: | 1982884763 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BANKS | ||||||||
FirstName: | HEATHER | ||||||||
MiddleName: | E. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 7142 SAN PEDRO AVE | ||||||||
Address2: | SUITE 120 | ||||||||
City: | SAN ANTONIO | ||||||||
State: | TX | ||||||||
PostalCode: | 782166256 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2106615622 | ||||||||
FaxNumber: | 2103954012 | ||||||||
Practice Location | |||||||||
Address1: | 2660 COMMON ST | ||||||||
Address2: | SUITE 201 | ||||||||
City: | NEW BRAUNFELS | ||||||||
State: | TX | ||||||||
PostalCode: | 781303584 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8306204650 | ||||||||
FaxNumber: | 8306204657 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/08/2007 | ||||||||
LastUpdateDate: | 08/06/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | M7027 | TX | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
ID | Type | State | Issuer | Description | P00780708 | 01 | TX | MEDICARE RAILROAD | OTHER | 204503101 | 05 | TX |   | MEDICAID |