Provider Demographics
NPI:1578383287
Name:BISHOP, CORMIERE VON (MHR, MED)
Entity type:Individual
Prefix:
First Name:CORMIERE
Middle Name:VON
Last Name:BISHOP
Suffix:
Gender:F
Credentials:MHR, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 OVERLAND TRL
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-8020
Mailing Address - Country:US
Mailing Address - Phone:405-887-4490
Mailing Address - Fax:
Practice Address - Street 1:1924 OVERLAND TRL
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-8020
Practice Address - Country:US
Practice Address - Phone:405-887-4490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management