Provider Demographics
NPI:1376547331
Name:BISHOP, COURTNEY L (MD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:L
Last Name:BISHOP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5680 W CHANDLER BLVD
Mailing Address - Street 2:STE 3
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-3341
Mailing Address - Country:US
Mailing Address - Phone:480-776-0440
Mailing Address - Fax:480-776-0444
Practice Address - Street 1:5680 W CHANDLER BLVD
Practice Address - Street 2:STE 3
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-3341
Practice Address - Country:US
Practice Address - Phone:480-776-0440
Practice Address - Fax:480-776-0444
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ24400208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ428278Medicaid