Healthcare Provider Details

I. General information

NPI: 1235161712
Provider Name (Legal Business Name): BISHER ABDULLAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/29/2021
Certification Date: 08/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 E MAIN STE D
PUYALLUP WA
98372-3199
US

IV. Provider business mailing address

1004 E MAIN STE D
PUYALLUP WA
98372-3199
US

V. Phone/Fax

Practice location:
  • Phone: 253-268-0720
  • Fax: 253-466-7072
Mailing address:
  • Phone: 253-740-0977
  • Fax: 253-466-7072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD00035982
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00035982
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberMD00035982
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: