MEDICARE: DR. LISA R MARTIN HAWVER MD

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	208600000X	Surgery Physician	2006006313	MO

General Provider Information

NPI Number	:	1952418055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA R MARTIN HAWVER MD

Provider Business Mailing Address
First Line	:	851 E 5TH ST STE 108
Second Line	:
City	:	WASHINGTON
State	:	MO
Zip	:	63090-3128
Country	:	US
Telephone Number	:	636-861-7870
Fax Number	:	636-861-7899

Provider Business Practice Location Address
First Line	:	851 E 5TH ST STE 108
Second Line	:
City	:	WASHINGTON
State	:	MO
Zip	:	63090-3128
Country	:	US
Telephone Number	:	636-861-7870
Fax Number	:	636-861-7899

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

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	05/23/2023

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