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NPI Code Detail

MEDICARE: KEITH FISHBECK DO

MEDICARE: KEITH FISHBECK DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207X00000XOrthopaedic Surgery PhysicianU2839TX
2207XX0005XSports Medicine (Orthopaedic Surgery) PhysicianU2839TX

General Provider Information

NPI Number : 1982145579
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEITH FISHBECK DO
Provider Business Mailing Address
First Line : 3414 GOLDEN RD
Second Line :
City : TYLER
State : TX
Zip : 75701-8336
Country : US
Telephone Number : 903-939-7500
Fax Number :
Provider Business Practice Location Address
First Line : 3816 N UNIVERSITY DR
Second Line :
City : NACOGDOCHES
State : TX
Zip : 75965-2011
Country : US
Telephone Number : 903-939-7500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2017
Last Update Date : 05/02/2025

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