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Individual

PHYLLIS R BISHOP

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5232
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5232

Taxonomy

Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
12091
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00119588
MS
05
1541168
LA
Enumeration date
06/16/2006
Last updated
06/14/2012
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