Provider Demographics
NPI:1629309026
Name:J A BIANCO D O P A
Entity Type:Organization
Organization Name:J A BIANCO D O P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BIANCO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-339-2153
Mailing Address - Street 1:2909 S HAMPTON RD
Mailing Address - Street 2:STE C108
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-3049
Mailing Address - Country:US
Mailing Address - Phone:214-339-2153
Mailing Address - Fax:214-751-2167
Practice Address - Street 1:2909 S HAMPTON RD
Practice Address - Street 2:STE C108
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-3000
Practice Address - Country:US
Practice Address - Phone:214-339-2153
Practice Address - Fax:214-751-2167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-25
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8661208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX031873501Medicaid
TXD97215Medicare UPIN