Healthcare Provider Details

I. General information

NPI: 1699741140
Provider Name (Legal Business Name): MEDICOR ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 CENTER ST SUITE 1
FREDONIA NY
14063-1716
US

IV. Provider business mailing address

12 CENTER ST SUITE 1
FREDONIA NY
14063
US

V. Phone/Fax

Practice location:
  • Phone: 716-679-2233
  • Fax: 716-679-9698
Mailing address:
  • Phone: 716-679-2233
  • Fax: 716-679-9698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: G JAY BISHOP
Title or Position: CORPORATION PRESIDENT
Credential: MD
Phone: 716-679-2233