Healthcare Provider Details

I. General information

NPI: 1548231186
Provider Name (Legal Business Name): DAVID KENT BISHOP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 OAK ST SE STE 5030
SALEM OR
97301-3991
US

IV. Provider business mailing address

2101 NE 139TH ST SUITE 350
VANCOUVER WA
98686-2309
US

V. Phone/Fax

Practice location:
  • Phone: 503-814-4480
  • Fax: 503-814-4482
Mailing address:
  • Phone: 360-256-4060
  • Fax: 360-256-0103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD00028406
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD162221
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: