Provider Demographics
NPI:1699735266
Name:BISHOP, ROGER E (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:E
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 1:512 N MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-2005
Mailing Address - Country:US
Mailing Address - Phone:217-347-7030
Mailing Address - Fax:217-347-7049
Practice Address - Street 1:512 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2005
Practice Address - Country:US
Practice Address - Phone:217-347-7030
Practice Address - Fax:217-347-7049
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL119416OtherHEALTHLINK
IL170983OtherPERSONAL CARE
IL0022540107OtherBLUE CROSS BLUE SHIELD IL
IL021101OtherHEALTH ALLIANCE
IL873557OtherFIRST HEALTH/ COVENTRY
IL371391171003Medicaid
IL371391171003Medicaid
IL371391171003Medicaid
ILL73903Medicare PIN