=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467458612
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BARBARA JO BIZUB PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2005
-----------------------------------------------------
Last Update Date | 06/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3722 BRIDGES ST
-----------------------------------------------------
City | MOREHEAD CITY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28557-2944
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-622-4033
-----------------------------------------------------
Fax | 252-240-3586
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3722 BRIDGES ST
-----------------------------------------------------
City | MOREHEAD CITY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28557-2944
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-622-4033
-----------------------------------------------------
Fax | 252-240-3586
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | MA003290L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 0010-07176
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------