Provider Demographics
NPI:1326339623
Name:SMITH, BIANCA (DO)
Entity Type:Individual
Prefix:DR
First Name:BIANCA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10097
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85130-0020
Mailing Address - Country:US
Mailing Address - Phone:520-836-3446
Mailing Address - Fax:520-836-8807
Practice Address - Street 1:44765 WEST HATHAWAY ROAD
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-0545
Practice Address - Country:US
Practice Address - Phone:520-788-6100
Practice Address - Fax:520-788-6140
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ006625207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z178880OtherMEDICARE
AZ023675Medicaid
03-1814OtherMEDICARE
031916OtherMEDICARE
ZFQ31814OtherMEDICARE
031815OtherMEDICARE