Healthcare Provider Details

I. General information

NPI: 1306885116
Provider Name (Legal Business Name): ROBERT G BISHOP M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 HIGHWAY 71 N
ALMA AR
72921-5114
US

IV. Provider business mailing address

825 HIGHWAY 71 N
ALMA AR
72921-5114
US

V. Phone/Fax

Practice location:
  • Phone: 479-632-6688
  • Fax: 479-632-0055
Mailing address:
  • Phone: 479-632-6688
  • Fax: 479-632-0055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC5638
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: