Provider Demographics
NPI:1548231186
Name:BISHOP, DAVID KENT (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:KENT
Last Name:BISHOP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 NE 139TH ST
Mailing Address - Street 2:SUITE 350
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-2309
Mailing Address - Country:US
Mailing Address - Phone:360-256-4060
Mailing Address - Fax:360-256-0103
Practice Address - Street 1:875 OAK ST SE STE 5030
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3991
Practice Address - Country:US
Practice Address - Phone:503-814-4480
Practice Address - Fax:503-814-4482
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00028406207V00000X
ORMD162221207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA160013267OtherMEDICARE RR
WA8128258Medicaid
WAG8855365Medicare PIN
WA8128258Medicaid