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General NPI Number Information
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NPI Number | 1093039703
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Entity Type | Organization
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Legal Business Name | LIESA HARTE, MD, PLLC
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Dates
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Enumeration Date | 03/24/2010
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Last Update Date | 09/27/2010
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Provider Practice Location Address
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Address Line | 1132 S LAMAR BLVD
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City | AUSTIN
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State | TX
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Zip | 78704-2300
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Country | US
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Telephone | 512-494-4304
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Fax |
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Provider Business Mailing Address
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Address Line | 1132 S LAMAR BLVD
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City | AUSTIN
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State | TX
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Zip | 78704-2300
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Country | US
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Telephone | 512-494-4304
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LIESA HARTE
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Credential | MD
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Telephone | 512-494-4304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | J5545
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License Number State | TX
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