Provider Demographics
NPI:1760487383
Name:BIANCHI, JOSEPH DEVERELL (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DEVERELL
Last Name:BIANCHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11945 SAN JOSE BLVD
Mailing Address - Street 2:BLDG 300
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-1613
Mailing Address - Country:US
Mailing Address - Phone:386-274-0250
Mailing Address - Fax:386-274-0269
Practice Address - Street 1:1890 LPGA BLVD
Practice Address - Street 2:STE 250
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-7130
Practice Address - Country:US
Practice Address - Phone:386-274-0250
Practice Address - Fax:386-274-0269
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75089208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006181OtherFHCP
FLG27839Medicare UPIN
FL42775YMedicare PIN