Provider Demographics
NPI:1912907940
Name:BISHOP, BRIAN ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:ROBERT
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 1:3601 S CLARKSON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3945
Mailing Address - Country:US
Mailing Address - Phone:720-833-0400
Mailing Address - Fax:303-788-7437
Practice Address - Street 1:3601 S CLARKSON ST STE 100
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3945
Practice Address - Country:US
Practice Address - Phone:720-833-0400
Practice Address - Fax:303-788-7437
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-01
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38281207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO47572582Medicaid
COCOA102945Medicare PIN
H16770Medicare UPIN
COC9391Medicare PIN