Provider Demographics
NPI:1609818616
Name:BISHOP, JON B (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:B
Last Name:BISHOP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 W 800 N
Mailing Address - Street 2:SUITE 442
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-6301
Mailing Address - Country:US
Mailing Address - Phone:801-802-0120
Mailing Address - Fax:801-802-0121
Practice Address - Street 1:700 W 800 N
Practice Address - Street 2:SUITE 442
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-6301
Practice Address - Country:US
Practice Address - Phone:801-802-0120
Practice Address - Fax:801-802-0121
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT36248312052082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTF21970Medicare UPIN
UT005735701Medicare PIN