Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | G1897 | TX |
NPI | 1063529055 |
---|---|
Provider Name | Michael Fischbach |
First Address | San Antonio, TX 78229 |
Second Address | San Antonio, TX 78229-4403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 27/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
042001001 | (05) | TX |