Healthcare Provider Details

I. General information

NPI: 1902331705
Provider Name (Legal Business Name): JOSHUA PAUL LISONBEE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2017
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 N GIBSON RD STE 430
HENDERSON NV
89011-1708
US

IV. Provider business mailing address

825 N GIBSON RD STE 430
HENDERSON NV
89011-1708
US

V. Phone/Fax

Practice location:
  • Phone: 702-565-6641
  • Fax:
Mailing address:
  • Phone: 702-565-6641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberEL6830
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2119
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: