Provider Demographics
NPI:1558996363
Name:BIANCHI, ALEXA RYANNE (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXA
Middle Name:RYANNE
Last Name:BIANCHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ALEXA
Other - Middle Name:RYANNE
Other - Last Name:WECKBACH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:14953 GENTRY DR
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-1587
Mailing Address - Country:US
Mailing Address - Phone:864-918-3651
Mailing Address - Fax:
Practice Address - Street 1:1711 DOOLITTLE AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76127-1133
Practice Address - Country:US
Practice Address - Phone:817-782-1706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-12
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101273235208D00000X, 2083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice