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NPI Code Detail

MEDICARE: LISA A. KING M.D,P.A.

MEDICARE: LISA A. KING M.D,P.A.
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
1207VE0102XReproductive Endocrinology PhysicianJ8015TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033204060
Entity Type Code : Organization
Provider Name (Legal Business Name) : LISA A. KING M.D,P.A.
Provider Business Mailing Address
First Line : PO BOX 674298
Second Line :
City : DALLAS
State : TX
Zip : 75267-4298
Country : US
Telephone Number : 972-709-9777
Fax Number :
Provider Business Practice Location Address
First Line : 950 SCOTLAND DR
Second Line :
City : DESOTO
State : TX
Zip : 75115-2057
Country : US
Telephone Number : 972-709-9777
Fax Number :
Authorized Official
Title or Position : BUSINESS MANAGER
Name : MRS. BEVERLY ANN BASS
Credential :
Telephone Number : 972-709-9777
Provider Enumeration Date : 10/04/2006
Last Update Date : 01/06/2020

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