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NPI Code Detail

MEDICARE: LISA ROUGRAFF LACORE P.A.-C

MEDICARE: LISA ROUGRAFF LACORE P.A.-C
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
1363A00000XPhysician Assistant
2363AS0400XSurgical Physician Assistant

General Provider Information

NPI Number : 1487077723
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA ROUGRAFF LACORE P.A.-C
Provider Business Mailing Address
First Line : 4400 LONG PRAIRIE RD
Second Line :
City : FLOWER MOUND
State : TX
Zip : 75028-1892
Country : US
Telephone Number : 469-322-7609
Fax Number :
Provider Business Practice Location Address
First Line : 4400 LONG PRAIRIE RD
Second Line :
City : FLOWER MOUND
State : TX
Zip : 75028-1892
Country : US
Telephone Number : 469-322-7609
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2014
Last Update Date : 06/10/2026

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