Provider Demographics
NPI:1275563801
Name:FISHMAN, JOSEPH HOWARD (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:HOWARD
Last Name:FISHMAN
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:PO BOX 24447
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33623-4447
Mailing Address - Country:US
Mailing Address - Phone:727-461-5872
Mailing Address - Fax:727-442-1600
Practice Address - Street 1:609 LAKEVIEW RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3335
Practice Address - Country:US
Practice Address - Phone:727-461-5872
Practice Address - Fax:727-442-1600
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME29604208200000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL79047OtherBCBS
D58630Medicare UPIN
FL79047ZMedicare ID - Type Unspecified