Provider Demographics
NPI:1497902498
Name:PRICE, MARY BISHOP (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BISHOP
Last Name:PRICE
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:PO BOX 841656
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1656
Mailing Address - Country:US
Mailing Address - Phone:903-531-5000
Mailing Address - Fax:
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2036
Practice Address - Country:US
Practice Address - Phone:903-531-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10025438207P00000X
TXN1422207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX199091305Medicaid
TX75-2616977-001OtherTRICARE
TX750818167022OtherTRICARE
TXTIN PLUS 015OtherTRICARE TYLER LOCATION
TX8BP168OtherBCBS
TX8DF420OtherBCBS
TX199091308Medicaid
TXP00735134OtherRAIL ROAD
TXP01304485OtherRAIL ROAD
TX199091304Medicaid
TX199091307Medicaid
TX8DU722OtherBCBS
TX75-0818167-048OtherTRICARE
TX75-2616977-002OtherTRICARE
TX75-2616977-028OtherTRICARE
TX8BZ886OtherBCBS
TXTIN PLUS 044OtherTRICARE WINNSBORO LOCATION
TXTIN PLUS 005OtherTRICARE JACKSONVILLE LOCATION
TXTIN PLUS 005OtherTRICARE JACKSONVILLE LOCATION
TX8L14830Medicare Oscar/Certification
TXP00735134Medicare PIN
TX8DU722OtherBCBS
TX75-2616977-001OtherTRICARE
TXTXB152813Medicare Oscar/Certification