Healthcare Provider Details

I. General information

NPI: 1053381343
Provider Name (Legal Business Name): LISA M. FLANNAGAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1899 EIDER CT
TALLAHASSEE FL
32308-4537
US

IV. Provider business mailing address

1899 EIDER CT
TALLAHASSEE FL
32308-4537
US

V. Phone/Fax

Practice location:
  • Phone: 850-878-5143
  • Fax: 850-942-6622
Mailing address:
  • Phone: 850-878-5143
  • Fax: 850-942-6622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License NumberME68348
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: