MEDICARE: DR. J A BIANCO D O P A

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	208600000X	Surgery Physician	D8661	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

General Provider Information

NPI Number	:	1912991365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. J A BIANCO D O P A

Provider Business Mailing Address
First Line	:	2909 S HAMPTON RD
Second Line	:	STE C108
City	:	DALLAS
State	:	TX
Zip	:	75224-3000
Country	:	US
Telephone Number	:	214-339-2153
Fax Number	:	214-339-3843

Provider Business Practice Location Address
First Line	:	2909 S HAMPTON RD
Second Line	:	STE C108
City	:	DALLAS
State	:	TX
Zip	:	75224-3000
Country	:	US
Telephone Number	:	214-339-2153
Fax Number	:	214-339-3843

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

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	03/02/2012

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Directions to “ DR. J A BIANCO D O P A” Practice Location

Language	Start Address	Practice Location

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