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General NPI Number Information
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NPI Number | 1487077723
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Entity Type | Individual
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Provider Name | LISA ROUGRAFF LACORE P.A.-C
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Gender | Female
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Dates
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Enumeration Date | 01/22/2014
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Last Update Date | 04/07/2017
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Provider Practice Location Address
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Address Line | 3901 W. 15TH STREET
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City | PLANO
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State | TX
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Zip | 75075
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Country | US
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Telephone | 972-345-2445
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Fax | 972-378-6749
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Provider Business Mailing Address
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Address Line | 1912 HAVERSHAM DRIVE
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City | FLOWER MOUND
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State | TX
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Zip | 75022
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Country | US
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Telephone | 972-345-2445
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Fax | 972-378-6749
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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