Healthcare Provider Details

I. General information

NPI: 1083933618
Provider Name (Legal Business Name): TIMOTHY FISHMAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2010
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 PARKVIEW DR STE 102
TROPHY CLUB TX
76262-4204
US

IV. Provider business mailing address

625 PARKVIEW DR STE 102
TROPHY CLUB TX
76262-4204
US

V. Phone/Fax

Practice location:
  • Phone: 917-667-4514
  • Fax: 469-620-7558
Mailing address:
  • Phone: 817-527-6537
  • Fax: 469-620-7558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number692183
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number006554
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: