Healthcare Provider Details

I. General information

NPI: 1538159991
Provider Name (Legal Business Name): LISA ANN PEREZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 03/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7145 PERKINS RD
BATON ROUGE LA
70808-4322
US

IV. Provider business mailing address

PO BOX 790213 SURGICAL ANESTHESIA OF BATON ROUGE LLC
SAINT LOUIS MO
63179-0213
US

V. Phone/Fax

Practice location:
  • Phone: 225-765-3111
  • Fax: 225-765-3114
Mailing address:
  • Phone: 636-549-2380
  • Fax: 314-569-5974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberL020650
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberL020650
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: