Individual
MR. RANDY LYMAN BISHOP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S.
Contact information
Practice address
650 MEDICAL DR, #68, POCATELLO, ID 83209-0001
(208) 282-4034
(208) 282-4571
Mailing address
650 MEDICAL DR, #68, POCATELLO, ID 83209-0001
(208) 282-4034
(208) 282-4571
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
AUD 1225
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AU 761
BLUE CROSS
ID
Enumeration date
07/14/2006
Last updated
07/08/2007
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