Individual
DR. CHANDI D'LEE BANKSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1315 12TH ST, ALAMOGORDO, NM 88310-5810
(505) 437-5716
(505) 437-5733
Mailing address
1315 12TH ST, ALAMOGORDO, NM 88310-5810
(505) 437-5716
(505) 437-5733
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A-1146-00
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
26422
—
NM
05
—
N6766
—
NM
01
—
NM014B53
BLUE CROSS/BLUE SHIELD
NM
Enumeration date
07/17/2006
Last updated
10/26/2007
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