Healthcare Provider Details

I. General information

NPI: 1508075961
Provider Name (Legal Business Name): LEIGH SORENSEN BISHOP M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5633 N LIDGERWOOD ST
SPOKANE WA
99208-1224
US

IV. Provider business mailing address

5633 N. LIDGERWOOD
SPOKANE WA
99208
US

V. Phone/Fax

Practice location:
  • Phone: 509-483-4629
  • Fax:
Mailing address:
  • Phone: 509-252-6336
  • Fax: 509-252-6337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00047997
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: