Healthcare Provider Details

I. General information

NPI: 1417927575
Provider Name (Legal Business Name): FRED L BISHOP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 N DAVIS SUITE 2
ARLINGTON TX
76012
US

IV. Provider business mailing address

PO BOX 120069
ARLINGTON TX
76012
US

V. Phone/Fax

Practice location:
  • Phone: 817-277-4723
  • Fax:
Mailing address:
  • Phone: 817-274-1999
  • Fax: 817-274-4671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG4830
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: