1730587999 NPI number — HISHAM BISMAR, MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730587999 NPI number — HISHAM BISMAR, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HISHAM BISMAR, MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730587999
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11807 SOUTH FREEWAY
Provider Second Line Business Mailing Address:
SUITE 362A
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76115-0337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-568-0004
Provider Business Mailing Address Fax Number:
817-568-0804

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11807 SOUTH FREEWAY
Provider Second Line Business Practice Location Address:
SUITE 362A
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76115-0337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-568-0004
Provider Business Practice Location Address Fax Number:
817-568-0804
Provider Enumeration Date:
12/19/2014

Additional Information

Authorized Official

Authorized Official Last Name:
BISMAR
Authorized Official First Name:
HISHAM
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
817-568-0004

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: TXB100274 . This is a "MEDICARE PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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