Provider Demographics
NPI:1629169552
Name:BIANCO, FERNANDO J (MD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:J
Last Name:BIANCO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:2140 W 68TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1815
Practice Address - Country:US
Practice Address - Phone:305-822-7227
Practice Address - Fax:305-827-6333
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2016-11-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME 101850208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01718267OtherSIMPLY
FLP1037439OtherFREEDOM
FL6004889OtherCIGNA
FL7695829OtherAETNA
FL53234OtherBCBS
FL319689OtherAVMED
FLP972690OtherOPTIMUM
FL1274120OtherWELLCARE
FLP01601017OtherRR MEDICARE
FL11827OtherDIMENSION
FL319689OtherAVMED