MEDICARE: KATHLEEN E MOORE BISHOP 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	207Q00000X	Family Medicine Physician	25817	AZ
2	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician	25817	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	220806	OTHER		INDIVIDUAL AHCCCS ID#

General Provider Information

NPI Number	:	1871701300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN E MOORE BISHOP MD

Provider Business Mailing Address
First Line	:	8180 E OCOTILLO DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85750-9665
Country	:	US
Telephone Number	:	520-749-3771
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 E FLORENCE BLVD
Second Line	:
City	:	CASA GRANDE
State	:	AZ
Zip	:	85122-5303
Country	:	US
Telephone Number	:	520-381-6105
Fax Number	:	520-381-6060

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

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	05/01/2017

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