Provider Demographics
NPI:1912991365
Name:BIANCO, J A (D O P A)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:A
Last Name:BIANCO
Suffix:
Gender:M
Credentials:D O P A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:75224-3000
Mailing Address - Country:US
Mailing Address - Phone:214-339-2153
Mailing Address - Fax:214-339-3843
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:214-339-3843
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8661208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX031873501Medicaid
TXD97215Medicare UPIN
TX0A5929Medicare PIN