Provider Demographics
NPI:1386617314
Name:BISHOP, BRITTON KEITH (MD)
Entity type:Individual
Prefix:DR
First Name:BRITTON
Middle Name:KEITH
Last Name:BISHOP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:689 MEDICAL PARK DR STE 204
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-5797
Mailing Address - Country:US
Mailing Address - Phone:865-271-6670
Mailing Address - Fax:
Practice Address - Street 1:689 MEDICAL PARK DR STE 204
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-5797
Practice Address - Country:US
Practice Address - Phone:865-271-6670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36934207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3879416Medicaid
4048754OtherBCBST
TNH73242Medicare UPIN
4048754OtherBCBST
TN3879416Medicare PIN