Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 12592 | WV |
N | 207U00000X | Nuclear Medicine Specialist | 12592 | WV |
NPI | 1760440663 |
---|---|
Provider Name | Harry Bishop |
First Address | Bridgeport, WV 26330-9303 |
Second Address | Bridgeport, WV 26330-1866 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C35037 | (02) | WV |