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General NPI Number Information
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NPI Number | 1821036500
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Entity Type | Individual
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Provider Name | JEROME P LISK MD
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Gender | Male
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 01/27/2021
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Provider Practice Location Address
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Address Line | 3120 MEDPARK DR STE 100
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City | DENTON
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State | TX
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Zip | 76208-6982
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Country | US
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Telephone | 940-383-1770
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Fax | 877-319-1848
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Provider Business Mailing Address
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Address Line | 3120 MEDPARK DR STE 100
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City | DENTON
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State | TX
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Zip | 76208-6982
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Country | US
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Telephone | 940-383-1770
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Fax | 877-319-1848
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 2004029825
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | R1074
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License Number State | TX
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