Provider Demographics
NPI:1194837732
Name:BISHARA, RIMA (MD)
Entity Type:Individual
Prefix:
First Name:RIMA
Middle Name:
Last Name:BISHARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RIMA
Other - Middle Name:
Other - Last Name:BOLTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4800 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76711-1329
Mailing Address - Country:US
Mailing Address - Phone:254-297-3000
Mailing Address - Fax:
Practice Address - Street 1:2115 N 34TH ST
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-3114
Practice Address - Country:US
Practice Address - Phone:254-755-8577
Practice Address - Fax:254-755-0078
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0920207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11-7378302Medicaid
TXF49317Medicare UPIN
TXOOK45D85T600Medicare ID - Type Unspecified