Bruce Grant Lyman Bishop, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

870346694 Issued in UT

Practice address

552 N Dixie Dr
St George, UT 84770-5551

Phone

(435) 703-9296

NPI assigned

Nov 9, 2006

Last updated

Apr 11, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT, MN2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Twin Ports Dermatology Inc

  • Physician Assistant
  • Duluth, MN
  • NPI 1316348725
  Medicare reassignment NPD
• Mt Ogden Eye Center LLC

  dba Utah Eye Centers

  • Ophthalmology Physician
  • Ogden, UT
  • NPI 1700927043
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554940800000",
    "number": "1174693733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 217",
            "city": "LAYTON",
            "state": "UT",
            "postal_code": "840410217",
            "telephone_number": "435-703-9296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "552 N DIXIE DR",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847705551",
            "telephone_number": "435-703-9296"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18325 N Allied Way Ste 120",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850543107",
            "country_code": "US",
            "telephone_number": "928-776-0325",
            "fax_number": "928-776-0405",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "203 S Candy Ln Ste 14",
            "address_purpose": "LOCATION",
            "city": "Cottonwood",
            "state": "AZ",
            "postal_code": "863264120",
            "country_code": "US",
            "telephone_number": "928-639-3387",
            "fax_number": "928-634-0311",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "830 Ainsworth Dr",
            "address_purpose": "LOCATION",
            "city": "Prescott",
            "state": "AZ",
            "postal_code": "863011630",
            "country_code": "US",
            "telephone_number": "928-776-0325",
            "fax_number": "928-776-0405",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2820 N Glassford Hill Rd Ste 107",
            "address_purpose": "LOCATION",
            "city": "Prescott Valley",
            "state": "AZ",
            "postal_code": "863142256",
            "country_code": "US",
            "telephone_number": "928-772-8553",
            "fax_number": "928-772-3861",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BISHOP",
        "first_name": "BRUCE",
        "middle_name": "GRANT LYMAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-09",
        "last_updated": "2019-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "UT",
            "license": "870346694",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristine Bird
• Ralph Gilbert Bird, RPH
• Ashley Nichole Birdzell
• Shantel Bishoff
• Autumn Bishop
• Carrie Idamae Bistline
• Sidena Bitton, SLP
• Cameron Talmage Black, M.D.
• Christopher D Black, D.O.
• Julia Black

• Dermatology Physician in St George, UT
• Providers in St George, UT by specialty
• Dermatology Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.