MEDICARE: GEORGE BLAINE BISHOP JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	13093	AL

General Provider Information

NPI Number	:	1407832348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE BLAINE BISHOP JR. MD

Provider Business Mailing Address
First Line	:	3686 GRANDVIEW PKWY STE 400
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35243-3404
Country	:	US
Telephone Number	:	205-595-8985
Fax Number	:	205-595-8987

Provider Business Practice Location Address
First Line	:	3686 GRANDVIEW PKWY STE 400
Second Line	:	SUITE 600
City	:	BIRMINGHAM
State	:	AL
Zip	:	35243-3404
Country	:	US
Telephone Number	:	205-595-8985
Fax Number	:	205-595-8987

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	05/22/2024

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