Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 0101222167 | VA |
NPI | 1740255637 |
---|---|
Provider Name | Craig Ernest Bischoff |
First Address | Suffolk, VA 23435 |
Second Address | Portsmouth, VA 23708-2197 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 08/07/2007 |