Individual
KENNETH BANKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2949 NEW BERN AVENUE, SUITE 112A, RALEIGH, NC 27610
(919) 255-1408
(919) 212-9029
Mailing address
PO BOX 707, DURHAM, NC 27702-0707
(919) 255-1408
(919) 212-9029
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
18602
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12978
BLUE CROSS BLUE SHIELD
NC
05
—
8912978
—
NC
Enumeration date
05/05/2006
Last updated
12/18/2012
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