Individual
GRANT THOMAS BISCHOF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
10 PAGE DR, PINEHURST, NC 28374-8848
(910) 295-6868
Mailing address
PO BOX 1749, PINEHURST, NC 28370-1749
(910) 295-7994
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-11179
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010-11179
LICENSE
NC
Enumeration date
04/27/2020
Last updated
03/07/2023
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