Provider Demographics
NPI:1134203631
Name:BISCHOF, JOHN K (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:K
Last Name:BISCHOF
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 1:315 SW 5TH AVE.
Mailing Address - Street 2:7TH FLOOR
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-1703
Mailing Address - Country:US
Mailing Address - Phone:503-416-4100
Mailing Address - Fax:503-416-3721
Practice Address - Street 1:315 SW 5TH AVE.
Practice Address - Street 2:7TH FLOOR
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-1703
Practice Address - Country:US
Practice Address - Phone:503-416-4100
Practice Address - Fax:503-416-3721
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD172212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR267898Medicaid
ORF05794Medicare UPIN