MEDICARE: PATRICK DEVERELL BIANCHI

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	174400000X	Specialist	ME74033	FL

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

General Provider Information

NPI Number	:	1538146048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK DEVERELL BIANCHI

Provider Business Mailing Address
First Line	:	3700 CAHABA BEACH RD
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-5225
Country	:	US
Telephone Number	:	205-403-8902
Fax Number	:	205-271-5590

Provider Business Practice Location Address
First Line	:	11513 N MAIN ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-4002
Country	:	US
Telephone Number	:	904-751-6200
Fax Number	:

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

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	06/15/2020

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