Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0401X | Internist - Addiction Medicine | 35957 | KY |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 35957 | KY |
NPI | 1578533766 |
---|---|
Provider Name | Marvin A Bishop |
First Address | Winchester, KY 40391-2494 |
Second Address | Winchester, KY 40391-2494 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 11/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64066186 | (05) | KY |
H81322 | (02) |