Provider Demographics
NPI:1427283464
Name:BISHOP, BRANDON WALLACE (DPM)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:WALLACE
Last Name:BISHOP
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Gender:M
Credentials:DPM
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Mailing Address - Street 1:2801 NW MERCY DR
Mailing Address - Street 2:STE. 340
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-2348
Mailing Address - Country:US
Mailing Address - Phone:541-677-4319
Mailing Address - Fax:541-677-2294
Practice Address - Street 1:2460 NW STEWART PKWY
Practice Address - Street 2:STE. 100
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-1516
Practice Address - Country:US
Practice Address - Phone:541-229-2663
Practice Address - Fax:541-229-0213
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2017-04-20
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Provider Licenses
StateLicense IDTaxonomies
ORDP177099213ES0103X, 213ES0103X
MI5901002283213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery