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Individual

DOUGLAS R BISHOP

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
2865 JAMES BLVD, POPLAR BLUFF, MO 63901-2803
(573) 776-1100
(573) 776-1107
Mailing address
190 INDUSTRIAL DR, FESTUS, MO 63028-4133
(636) 638-1506
(636) 638-1507

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2009003804
MO
363LA2200X
Adult Health Nurse Practitioner
Primary
2014038385
MO
363LG0600X
Gerontology Nurse Practitioner
2014038385
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
APPLYING
MO
Enumeration date
11/14/2014
Last updated
11/14/2014
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