Healthcare Provider Details

I. General information

NPI: 1467458612
Provider Name (Legal Business Name): BARBARA JO BIZUB PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3722 BRIDGES ST
MOREHEAD CITY NC
28557-2944
US

IV. Provider business mailing address

3722 BRIDGES ST
MOREHEAD CITY NC
28557-2944
US

V. Phone/Fax

Practice location:
  • Phone: 252-622-4033
  • Fax: 252-240-3586
Mailing address:
  • Phone: 252-622-4033
  • Fax: 252-240-3586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA003290L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-07176
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: