Provider Demographics
NPI:1306120548
Name:BANEY, RICHARD NEIL (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:NEIL
Last Name:BANEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 LANSING ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-5355
Mailing Address - Country:US
Mailing Address - Phone:321-773-4345
Mailing Address - Fax:
Practice Address - Street 1:1460 BAYTREE DR NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-3900
Practice Address - Country:US
Practice Address - Phone:321-914-0915
Practice Address - Fax:321-914-0916
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME16743207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME16743OtherMEDICAL LICENSE NUMBER