=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154536498
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | F WATT BISHOP DDS,MS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 306 S LAMAR BLVD
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38655-4012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-234-4822
-----------------------------------------------------
Fax | 662-234-9032
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P O BOX 1218
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38655-1218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-234-4822
-----------------------------------------------------
Fax | 662-234-9032
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | OR-002-76
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------