Individual
CHARLES G BISHOP JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12 GINGER CREEK PARKWAY, GLEN CARBON, IL 62034
(618) 656-8200
Mailing address
1326 RAINFIELD GARDENS COURT, O'FALLON, IL 62269
(618) 531-6818
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036106182
IL
207LP2900X
Pain Medicine (Anesthesiology) Physician
036106182
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036106182
—
IL
Enumeration date
12/14/2005
Last updated
12/26/2014
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