Provider Demographics
NPI:1235192659
Name:BISHOP, JEFFREY MARK (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MARK
Last Name:BISHOP
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3172 SE FAIRWAY W
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-6045
Mailing Address - Country:US
Mailing Address - Phone:561-718-5848
Mailing Address - Fax:561-791-4682
Practice Address - Street 1:750 S MILITARY TRL STE D&E
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-3963
Practice Address - Country:US
Practice Address - Phone:561-560-2603
Practice Address - Fax:561-560-2604
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0005102207Q00000X
GA40316207Q00000X
FLOS5102207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
003534OtherNHP
102250OtherUNITED HEALTH CARE
FL044080900Medicaid
1685824OtherCIGNA
208915OtherAVMED
4201051OtherAETNA
28745OtherHEALTH EASE
D60746OtherVISTA
003534OtherNHP
28745OtherHEALTH EASE