Provider Demographics
NPI:1124199286
Name:BISHARA, MUNIR FARIZ (MD)
Entity Type:Individual
Prefix:
First Name:MUNIR
Middle Name:FARIZ
Last Name:BISHARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 MAIN ST
Mailing Address - Street 2:5200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-4612
Mailing Address - Country:US
Mailing Address - Phone:214-712-2000
Mailing Address - Fax:214-712-2444
Practice Address - Street 1:1717 MAIN ST
Practice Address - Street 2:5200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-4612
Practice Address - Country:US
Practice Address - Phone:214-712-2000
Practice Address - Fax:214-712-2444
Is Sole Proprietor?:No
Enumeration Date:2006-11-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8862208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMDD8862OtherWORK COMP