Provider Demographics
NPI:1629057377
Name:BISHOP, ELLIE LYNN (DO)
Entity type:Individual
Prefix:
First Name:ELLIE
Middle Name:LYNN
Last Name:BISHOP
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-222-7010
Mailing Address - Fax:515-222-7037
Practice Address - Street 1:580 SW 9TH ST STE 100
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1271
Practice Address - Country:US
Practice Address - Phone:515-282-2489
Practice Address - Fax:515-243-1461
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2025-03-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA3637207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I36160Medicare UPIN