Healthcare Provider Details

I. General information

NPI: 1225016819
Provider Name (Legal Business Name): BERNARD FISCHBACH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 8TH AVE STE 135
FORT WORTH TX
76104-4156
US

IV. Provider business mailing address

1505 LBJ FWY STE 700
DALLAS TX
75234-6065
US

V. Phone/Fax

Practice location:
  • Phone: 214-358-2300
  • Fax: 214-579-6993
Mailing address:
  • Phone: 214-358-2300
  • Fax: 214-579-6941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberL6378
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: