Provider Demographics
NPI:1730587999
Name:HISHAM BISMAR, MD
Entity type:Organization
Organization Name:HISHAM BISMAR, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
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
Mailing Address - Street 2:SUITE 362A
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76115-0337
Mailing Address - Country:US
Mailing Address - Phone:817-568-0004
Mailing Address - Fax:817-568-0804
Practice Address - Street 1:11807 SOUTH FREEWAY
Practice Address - Street 2:SUITE 362A
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76115-0337
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:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB100274OtherMEDICARE PTAN