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General NPI Number Information
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NPI Number | 1407846850
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Entity Type | Individual
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Provider Name | JAY R BISHOP D.O.
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Gender | Male
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 350 W COUNTRY CLUB RD SUITE#205
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City | ROSWELL
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State | NM
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Zip | 88201-5205
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Country | US
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Telephone | 575-622-7593
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Fax | 575-622-5538
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Provider Business Mailing Address
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Address Line | 800 BRADBURY DR SE STE 116
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-4310
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Country | US
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Telephone | 505-272-1476
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 46011
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | A-1577-10
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License Number State | NM
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