MEDICARE: STACIE LYNN BINGAMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	01055347A	IN
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	N2584	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073715165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACIE LYNN BINGAMAN MD

Provider Business Mailing Address
First Line	:	1617 HEMPHILL ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4709
Country	:	US
Telephone Number	:	817-702-2396
Fax Number	:	817-927-3603

Provider Business Practice Location Address
First Line	:	400 W ARBROOK BLVD STE 300
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76014-3174
Country	:	US
Telephone Number	:	972-647-8404
Fax Number	:	972-641-8398

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2007
Last Update Date	:	03/28/2025

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Directions to “ STACIE LYNN BINGAMAN MD” Practice Location

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