Healthcare Provider Details

I. General information

NPI: 1306818232
Provider Name (Legal Business Name): THOMAS DEVERELL BIANCHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2006
Last Update Date: 06/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 HERREN HILL RD SUITE E
TALLASSEE AL
36078-1263
US

IV. Provider business mailing address

80 HERREN HILL RD SUITE E
TALLASSEE AL
36078-1263
US

V. Phone/Fax

Practice location:
  • Phone: 334-283-3862
  • Fax:
Mailing address:
  • Phone: 334-283-3862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number8344
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number8344
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: