Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0221X | Pediatric Dentist | D7527 | AZ |
Y | 1223P0221X | Pediatric Dentist | D9489 | OR |
NPI | 1073772299 |
---|---|
Provider Name | Brian S. Bishop |
First Address | Medford, OR 97504-6186 |
Second Address | Medford, OR 97504-6186 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2008 |
Last Update Date | 14/06/2011 |