Basic Information
Provider Information
NPI: 1982170098
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BISHOP
FirstName: ANTHONY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
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OtherCredential:  
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Mailing Information
Address1: PO BOX 110429
Address2:  
City: AURORA
State: CO
PostalCode: 800420429
CountryCode: US
TelephoneNumber: 3034937000
FaxNumber:  
Practice Location
Address1: 13123 E 16TH AVE
Address2:  
City: AURORA
State: CO
PostalCode: 800457106
CountryCode: US
TelephoneNumber: 7207771234
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/16/2018
LastUpdateDate: 07/27/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/27/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000XPA.0005904COY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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