Healthcare Provider Details

I. General information

NPI: 1518978097
Provider Name (Legal Business Name): LISA JOAN PFITZER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12680 OLIVE BLVD STE 200
SAINT LOUIS MO
63141-6322
US

IV. Provider business mailing address

12680 OLIVE BLVD STE 200
SAINT LOUIS MO
63141-6322
US

V. Phone/Fax

Practice location:
  • Phone: 314-529-5660
  • Fax: 314-529-5665
Mailing address:
  • Phone: 314-529-5660
  • Fax: 314-529-5665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number36493
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2080C0008X
TaxonomyChild Abuse Pediatrics Physician
License Number36493
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3012736
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code2080C0008X
TaxonomyChild Abuse Pediatrics Physician
License Number2022018676
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: