Healthcare Provider Details

I. General information

NPI: 1578686382
Provider Name (Legal Business Name): LISA BRONE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2007
Last Update Date: 08/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 S BRIGGS ST STE 103B
ERIE CO
80516-4064
US

IV. Provider business mailing address

149 S BRIGGS ST STE 103B
ERIE CO
80516-4064
US

V. Phone/Fax

Practice location:
  • Phone: 720-563-9469
  • Fax:
Mailing address:
  • Phone: 720-563-9469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number38561
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: