Provider Demographics
NPI:1346259314
Name:BISH, DONETTE LOUISE (DO)
Entity Type:Individual
Prefix:
First Name:DONETTE
Middle Name:LOUISE
Last Name:BISH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 ELBA HWY
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36079-6020
Mailing Address - Country:US
Mailing Address - Phone:334-670-6726
Mailing Address - Fax:334-670-6731
Practice Address - Street 1:1412 ELBA HWY
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36079
Practice Address - Country:US
Practice Address - Phone:334-566-8822
Practice Address - Fax:334-566-8128
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO-914207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL631805043Medicaid
AL051003454OtherBLUECROSS AND BLUE SHIELD
AL631805043Medicaid