Provider Demographics
NPI:1003901703
Name:BISHOP, BEVERLY BROWN (MD)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:BROWN
Last Name:BISHOP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 UPTOWN BLVD
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-3507
Mailing Address - Country:US
Mailing Address - Phone:972-637-1300
Mailing Address - Fax:866-353-7586
Practice Address - Street 1:634 UPTOWN BLVD
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-3507
Practice Address - Country:US
Practice Address - Phone:972-637-1300
Practice Address - Fax:866-353-7586
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3101207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0898808OtherAETNA HMO
0898808OtherAETNA POS
TX180028816OtherMEDICARE RR DALLAS COUNTY
TX0016DQOtherBCBS GROUP
TX86772XOtherBCBS PROVIDER ID
TX122177205Medicaid
5248549OtherAETNA PPO
TX180034452OtherMEDICARE RR ELLIS COUNTY
4146505OtherBCBD BLUE LINK
TX122177206Medicaid
UNITED HEALTHCAREOther751622524
TX180028816OtherMEDICARE RR DALLAS COUNTY
TX8F9500Medicare PIN
UNITED HEALTHCAREOther751622524
TXG46505Medicare UPIN