Provider Demographics
NPI:1710995899
Name:BISCHOFF, SCOTT BARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:BARRY
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 1:10521 CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-4003
Mailing Address - Country:US
Mailing Address - Phone:281-277-7997
Mailing Address - Fax:281-277-8117
Practice Address - Street 1:10521 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-4003
Practice Address - Country:US
Practice Address - Phone:281-277-7997
Practice Address - Fax:281-277-8117
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6055207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8S2113OtherBCBS