Basic Information
| Provider Information | |||||||||
| NPI: | 1003294604 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BISHOP | ||||||||
| FirstName: | MICAH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DVM, DACVIM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10130 MARKET ST | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341123444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2392630480 | ||||||||
| FaxNumber: | 2392630488 | ||||||||
| Practice Location | |||||||||
| Address1: | 10130 MARKET ST | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341123444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2392630480 | ||||||||
| FaxNumber: | 2392630488 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2015 | ||||||||
| LastUpdateDate: | 05/14/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174M00000X | VM12748 | FL | Y | Other Service Providers | Veterinarian | 174M00000X | 10569 | TX | N | Other Service Providers | Veterinarian |
No ID Information.