Healthcare Provider Details

I. General information

NPI: 1184690802
Provider Name (Legal Business Name): LISA JOY HANSARD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 05/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 NORTH MOPAC BLDG I, SUITE 1200
AUSTIN TX
78731
US

IV. Provider business mailing address

6500 NORTH MOPAC BLDG I, SUITE 1200
AUSTIN TX
78731
US

V. Phone/Fax

Practice location:
  • Phone: 512-451-0149
  • Fax: 512-451-0977
Mailing address:
  • Phone: 512-451-0149
  • Fax: 512-451-0977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberH8109
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: