Basic Information
| Provider Information | |||||||||
| NPI: | 1437375094 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BISHOP | ||||||||
| FirstName: | CHRISTIANNE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 COFFEE ROAD | ||||||||
| Address2: | SUTTER GOULD MEDICAL FOUNDATION | ||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095216097 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 COFFEE ROAD | ||||||||
| Address2: | SUTTER GOULD MEDICAL FOUNDATION | ||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095241211 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2007 | ||||||||
| LastUpdateDate: | 10/31/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A73675 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QG0300X | A73675 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine | 207QH0002X | A73675 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8313223 | 05 | WA | MEDICAID |