Provider Demographics
NPI:1588680508
Name:BISCHOFF, THOMAS WARREN (CRNA)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:WARREN
Last Name:BISCHOFF
Suffix:
Gender:M
Credentials:CRNA
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 249
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:OR
Mailing Address - Zip Code:97027-0249
Mailing Address - Country:US
Mailing Address - Phone:503-650-4359
Mailing Address - Fax:503-650-6913
Practice Address - Street 1:800 E WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-8359
Practice Address - Country:US
Practice Address - Phone:707-464-8511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1107367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
R20364Medicare UPIN
CAZZZ29646ZMedicare ID - Type Unspecified