MEDICARE: DR. DEREK NIEBER M.D.

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
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	T8003	TX

General Provider Information

NPI Number	:	1992184675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEREK NIEBER M.D.

Provider Business Mailing Address
First Line	:	757 8TH AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2522
Country	:	US
Telephone Number	:	817-336-4454
Fax Number	:	817-336-4440

Provider Business Practice Location Address
First Line	:	757 8TH AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2522
Country	:	US
Telephone Number	:	817-336-4454
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2015
Last Update Date	:	08/20/2024

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