MEDICARE: DR. JERRY W 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
1	207Q00000X	Family Medicine Physician	ME92732	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00652865	OTHER	FL	RAILROAD MEDICARE PROVIDER NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982607875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERRY W BISHOP M.D.

Provider Business Mailing Address
First Line	:	13933 17TH ST STE 101
Second Line	:
City	:	DADE CITY
State	:	FL
Zip	:	33525-4604
Country	:	US
Telephone Number	:	352-567-6763
Fax Number	:	352-567-2146

Provider Business Practice Location Address
First Line	:	13933 17TH ST STE 101
Second Line	:
City	:	DADE CITY
State	:	FL
Zip	:	33525-4604
Country	:	US
Telephone Number	:	352-567-6763
Fax Number	:	352-567-2146

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	02/10/2020

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