Healthcare Provider Details

I. General information

NPI: 1710995899
Provider Name (Legal Business Name): SCOTT BARRY BISCHOFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10521 CORPORATE DR
STAFFORD TX
77477-4003
US

IV. Provider business mailing address

10521 CORPORATE DR
STAFFORD TX
77477-4003
US

V. Phone/Fax

Practice location:
  • Phone: 281-277-7997
  • Fax: 281-277-8117
Mailing address:
  • Phone: 281-277-7997
  • Fax: 281-277-8117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License NumberH6055
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: