Provider Demographics
NPI:1235783283
Name:BISHOP, MICHAEL L (GRADUATING MEDICAL S)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:L
Last Name:BISHOP
Suffix:
Gender:M
Credentials:GRADUATING MEDICAL S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:684 CR 785
Mailing Address - Street 2:
Mailing Address - City:DOUGLASS
Mailing Address - State:TX
Mailing Address - Zip Code:75943
Mailing Address - Country:US
Mailing Address - Phone:936-645-1586
Mailing Address - Fax:
Practice Address - Street 1:1303 N. MOUND STREET
Practice Address - Street 2:
Practice Address - City:NACODOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961
Practice Address - Country:US
Practice Address - Phone:409-837-2468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program