Provider Demographics
NPI:1053485284
Name:TISHERMAN, DARRYL B (MD)
Entity Type:Individual
Prefix:
First Name:DARRYL
Middle Name:B
Last Name:TISHERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2021 N MACARTHUR BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-2222
Mailing Address - Country:US
Mailing Address - Phone:972-253-4354
Mailing Address - Fax:972-253-4218
Practice Address - Street 1:2021 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2222
Practice Address - Country:US
Practice Address - Phone:972-253-4354
Practice Address - Fax:972-253-4218
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8149207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD93673Medicare UPIN
TX8160J3Medicare ID - Type Unspecified