Provider Demographics
NPI:1912194135
Name:HISHAM BISMAR MD PA
Entity Type:Organization
Organization Name:HISHAM BISMAR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HISHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BISMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-568-0004
Mailing Address - Street 1:11807 SOUTH FREEWAY, STE 362
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76115
Mailing Address - Country:US
Mailing Address - Phone:817-568-0004
Mailing Address - Fax:817-568-0804
Practice Address - Street 1:11807 SOUTH FREEWAY, STE 362
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76115
Practice Address - Country:US
Practice Address - Phone:817-568-0004
Practice Address - Fax:817-568-0804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0052BDOtherMEDICARE GROUP
TX0052BDOtherMEDICARE GROUP