Individual
THERAL MICHAEL BISHOP
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1400 N 500 E, LOGAN, UT 84341
(435) 716-1000
Mailing address
PO BOX 25535, SALT LAKE CITY, UT 84125
(800) 789-7342
(616) 975-9827
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
1493181205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03874
—
UT
Enumeration date
06/09/2006
Last updated
07/08/2007
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