Provider Demographics
NPI:1174693733
Name:BISHOP, BRUCE GRANT LYMAN (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:GRANT LYMAN
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:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-0217
Mailing Address - Country:US
Mailing Address - Phone:435-703-9296
Mailing Address - Fax:
Practice Address - Street 1:552 N DIXIE DR
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-5551
Practice Address - Country:US
Practice Address - Phone:435-703-9296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT870346694207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000004342Medicare PIN
UT000004342Medicare ID - Type Unspecified