Healthcare Provider Details

I. General information

NPI: 1821268533
Provider Name (Legal Business Name): WILLIAM DAE BISHOP D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 07/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W HUNTINGTON DR PATHOLOGY DEPT
ARCADIA CA
91007-3402
US

IV. Provider business mailing address

300 W HUNTINGTON DR PATHOLOGY DEPT
ARCADIA CA
91007-3402
US

V. Phone/Fax

Practice location:
  • Phone: 626-574-3488
  • Fax:
Mailing address:
  • Phone: 626-574-3488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number20A10631
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: