Physician Compare National (NPI:1235329467)

HEALTHCARE PROVIDER: TIMOTHY MICHAEL FISHBACK MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1235329467
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6103094909
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110721000796
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	FISHBACK
	Individual professional last name
Provider First Name	TIMOTHY
	Individual professional first name
Provider Middle Name	MICHAEL
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	CLVLND CLINIC LERNER COLLEGE OF MED OF CASE WSTN RSV UNIVERSITY
	Individual professional's medical school
Graduation Year	1985
	Individual professional's medical school graduation year
Primary Specialty	PSYCHIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	3022 N AVENIDA CABALLEROS
	Group Practice or individual's line 1 address
City	PALM SPRINGS
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	922622390
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7609927162
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y