MEDICARE: MS. BARBARA JO BIZUB PA-C

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	363AM0700X	Medical Physician Assistant	MA003290L	PA
2	363A00000X	Physician Assistant	0010-07176	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	970024858	OTHER	PA	PALMETTO GBA(RR MEDICARE)

General Provider Information

NPI Number	:	1467458612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BARBARA JO BIZUB PA-C

Provider Business Mailing Address
First Line	:	3722 BRIDGES ST
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-2944
Country	:	US
Telephone Number	:	252-622-4033
Fax Number	:	252-240-3586

Provider Business Practice Location Address
First Line	:	3722 BRIDGES ST
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-2944
Country	:	US
Telephone Number	:	252-622-4033
Fax Number	:	252-240-3586

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	06/05/2024

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