Provider Demographics
NPI:1205076049
Name:BISHOP, ROBERT G
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:BISHOP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:
Other - Last Name:BISHOP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:1725 S.E. 164TH CIR.
Mailing Address - Street 2:
Mailing Address - City:OCKLAWAHA
Mailing Address - State:FL
Mailing Address - Zip Code:32179
Mailing Address - Country:US
Mailing Address - Phone:352-625-3620
Mailing Address - Fax:
Practice Address - Street 1:1725 S.E. 164TH CIRCLE
Practice Address - Street 2:
Practice Address - City:OCKLAWAHA
Practice Address - State:FL
Practice Address - Zip Code:32179
Practice Address - Country:US
Practice Address - Phone:352-625-3620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9169045163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse