Provider Demographics
NPI:1821299108
Name:FLEISHMAN, JUSTIN N (MD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:N
Last Name:FLEISHMAN
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:SUITE 5200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-4612
Mailing Address - Country:US
Mailing Address - Phone:512-653-4989
Mailing Address - Fax:
Practice Address - Street 1:1717 MAIN ST
Practice Address - Street 2:SUITE 5200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-4612
Practice Address - Country:US
Practice Address - Phone:512-653-4989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXM8651207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
BP1-0026723OtherINSTITUTIONAL PERMIT