Provider Demographics
NPI:1396714713
Name:BISHOP, JOHN BARRY (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BARRY
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 1:24 MEMORIAL MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4452
Mailing Address - Country:US
Mailing Address - Phone:864-295-4160
Mailing Address - Fax:864-295-0445
Practice Address - Street 1:24 MEMORIAL MEDICAL DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4452
Practice Address - Country:US
Practice Address - Phone:864-295-4160
Practice Address - Fax:864-295-0445
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC91522086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC1798Medicaid
SCD99241Medicare UPIN
SCPC1798Medicaid