Healthcare Provider Details

I. General information

NPI: 1619068301
Provider Name (Legal Business Name): PETER M BIANCO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5333 N UNION BLVD STE 200
COLORADO SPRINGS CO
80918-2051
US

IV. Provider business mailing address

5333 N UNION BLVD STE 200
COLORADO SPRINGS CO
80918-2051
US

V. Phone/Fax

Practice location:
  • Phone: 719-598-0500
  • Fax: 719-268-6834
Mailing address:
  • Phone: 719-598-0500
  • Fax: 719-268-6834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number27337
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: