Provider Demographics
NPI:1083933618
Name:FISHMAN, TIMOTHY (DPM)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:FISHMAN
Suffix:
Gender:
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 PARKVIEW DR STE 102
Mailing Address - Street 2:
Mailing Address - City:TROPHY CLUB
Mailing Address - State:TX
Mailing Address - Zip Code:76262-4204
Mailing Address - Country:US
Mailing Address - Phone:917-667-4514
Mailing Address - Fax:469-620-7558
Practice Address - Street 1:625 PARKVIEW DR STE 102
Practice Address - Street 2:
Practice Address - City:TROPHY CLUB
Practice Address - State:TX
Practice Address - Zip Code:76262-4204
Practice Address - Country:US
Practice Address - Phone:917-667-4514
Practice Address - Fax:469-620-7558
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-21
Last Update Date:2025-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006554213ES0103X
390200000X
TX692183213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program