Healthcare Provider Details

I. General information

NPI: 1831540103
Provider Name (Legal Business Name): JOSEPH BISHARA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W 16TH ST
PUEBLO CO
81003-2745
US

IV. Provider business mailing address

908 POTTER DR
COLORADO SPRINGS CO
80909-5438
US

V. Phone/Fax

Practice location:
  • Phone: 719-595-7585
  • Fax: 719-595-7982
Mailing address:
  • Phone: 719-360-5570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDR.0059807
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number000593
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: