Provider Demographics
NPI:1487642716
Name:BISCHOFF, ROBERT ALLYN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALLYN
Last Name:BISCHOFF
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 1:105 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:BELLE PLAINE
Mailing Address - State:IA
Mailing Address - Zip Code:52208-2200
Mailing Address - Country:US
Mailing Address - Phone:319-444-3210
Mailing Address - Fax:319-444-1078
Practice Address - Street 1:105 9TH AVE
Practice Address - Street 2:
Practice Address - City:BELLE PLAINE
Practice Address - State:IA
Practice Address - Zip Code:52208-2200
Practice Address - Country:US
Practice Address - Phone:319-444-3210
Practice Address - Fax:319-444-1078
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26642207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00466589OtherRR MEDICARE
IA4043067Medicaid
IA48989Medicare ID - Type Unspecified
IAI21201Medicare PIN
IA4043067Medicaid
IAP00466589OtherRR MEDICARE