Provider Demographics
NPI:1740800705
Name:BISHOP, LAUREN ELISABETH (MD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ELISABETH
Last Name:BISHOP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ELISABETH
Other - Last Name:FULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2961 MOSSROCK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5119
Mailing Address - Country:US
Mailing Address - Phone:210-731-4800
Mailing Address - Fax:210-731-4810
Practice Address - Street 1:1248 AUSTIN HWY STE 214
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-4867
Practice Address - Country:US
Practice Address - Phone:210-828-2531
Practice Address - Fax:210-828-2532
Is Sole Proprietor?:No
Enumeration Date:2020-04-20
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU5076207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine