MEDICARE: DR. LARRY J BISCHOF M.D., PH.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician	ME 109929	FL

General Provider Information

NPI Number	:	1952597619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY J BISCHOF M.D., PH.D

Provider Business Mailing Address
First Line	:	3001 W. DR. MARTIN LUTHER KING JR, BLVD
Second Line	:	ST. JOSEPH'S HOSPITAL, DEPARTMENT OF PATHOLOGY
City	:	TAMPA
State	:	FL
Zip	:	33607
Country	:	US
Telephone Number	:	813-357-1671
Fax Number	:

Provider Business Practice Location Address
First Line	:	3001 W. DR. MARTIN LUTHER KING JR, BLVD
Second Line	:	ST. JOSEPH'S HOSPITAL, DEPARTMENT OF PATHOLOGY
City	:	TAMPA
State	:	FL
Zip	:	33607
Country	:	US
Telephone Number	:	813-357-1671
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2007
Last Update Date	:	08/04/2011

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