Provider Demographics
NPI:1407888126
Name:BISHOP, JOHN WARREN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:WARREN
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 1:800 BRADBURY DR SE STE 116
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4310
Mailing Address - Country:US
Mailing Address - Phone:052-721-4765
Mailing Address - Fax:
Practice Address - Street 1:4001 SILVERY MINNOW PL NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-4741
Practice Address - Country:US
Practice Address - Phone:513-256-5290
Practice Address - Fax:505-369-1686
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2020-0976207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000302668OtherANTHEM
OH495750001OtherCARESOURCE
KY64069800Medicaid
OH11-01348OtherUNITED HEALTHCARE
IN200453860Medicaid
OH2422524Medicaid
OH7107142OtherAETNA
OH11-01348OtherUNITED HEALTHCARE
OHC13476Medicare UPIN