Provider Demographics
NPI:1912093246
Name:BISH, DAVID CLARENCE (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CLARENCE
Last Name:BISH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:AL
Mailing Address - Zip Code:36027-1855
Mailing Address - Country:US
Mailing Address - Phone:334-688-7276
Mailing Address - Fax:334-687-0028
Practice Address - Street 1:820 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:AL
Practice Address - Zip Code:36027-1855
Practice Address - Country:US
Practice Address - Phone:334-688-7276
Practice Address - Fax:334-687-0028
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO-894208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-01710OtherBCBS
ALP00230660OtherRAILROAD MEDICARE