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NPI Code Detail

MEDICARE: DR. SCOTT RUSSELL BISHOP M.D.

MEDICARE: DR. SCOTT RUSSELL BISHOP M.D.
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
1207Q00000XFamily Medicine Physician22441NE

General Provider Information

NPI Number : 1962493486
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SCOTT RUSSELL BISHOP M.D.
Provider Business Mailing Address
First Line : PO BOX 337
Second Line :
City : LAYTON
State : UT
Zip : 84041-0337
Country : US
Telephone Number : 801-773-4840
Fax Number : 801-525-8151
Provider Business Practice Location Address
First Line : 2038 W 1900 S
Second Line :
City : SYRACUSE
State : UT
Zip : 84075-9320
Country : US
Telephone Number : 801-773-4840
Fax Number : 801-926-1032
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2005
Last Update Date : 08/29/2017

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