Provider Demographics
NPI:1033505094
Name:METHVIN, BIANCA LOVE
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:LOVE
Last Name:METHVIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BIANCA
Other - Middle Name:
Other - Last Name:LOVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1025 W. US HWY 175
Mailing Address - Street 2:
Mailing Address - City:CRANDALL
Mailing Address - State:TX
Mailing Address - Zip Code:75114
Mailing Address - Country:US
Mailing Address - Phone:972-472-3800
Mailing Address - Fax:
Practice Address - Street 1:1025 W. US HWY 175
Practice Address - Street 2:
Practice Address - City:CRANDALL
Practice Address - State:TX
Practice Address - Zip Code:75114
Practice Address - Country:US
Practice Address - Phone:972-472-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR6623208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics