Provider Demographics
NPI:1871705210
Name:BANKS, SHANE B (DO)
Entity type:Individual
Prefix:DR
First Name:SHANE
Middle Name:B
Last Name:BANKS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:GRANT
Mailing Address - State:NE
Mailing Address - Zip Code:69140-3095
Mailing Address - Country:US
Mailing Address - Phone:308-352-7200
Mailing Address - Fax:308-352-7290
Practice Address - Street 1:900 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:GRANT
Practice Address - State:NE
Practice Address - Zip Code:69140-3095
Practice Address - Country:US
Practice Address - Phone:308-352-7200
Practice Address - Fax:308-352-7290
Is Sole Proprietor?:No
Enumeration Date:2007-05-06
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE546208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery