Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD021840 | TN |
Y | 2080P0204X | Pediatric Emergency Doctor | MD021840 | TN |
NPI | 1083650717 |
---|---|
Provider Name | Dr. Jan Bishop |
First Address | Knoxville, TN 37932-1984 |
Second Address | Knoxville, TN 37916-2301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 20/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3028314 | BLUE CROSS (01) | TN |
3063923 | (05) | TN |
64910458 | (05) | KY |