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NPI Code Detail

MEDICARE: DR. LISA A. DUCHAMP M.D.

MEDICARE: DR. LISA A. DUCHAMP M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianK0288TX
2208000000XPediatrics PhysicianK0288TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
38L9750OTHERTXMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
28BZ262OTHERTXBCBS
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134145675
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LISA A. DUCHAMP M.D.
Provider Business Mailing Address
First Line : PO BOX 99371
Second Line :
City : FORT WORTH
State : TX
Zip : 76199-0371
Country : US
Telephone Number : 682-885-1855
Fax Number : 682-885-7347
Provider Business Practice Location Address
First Line : 1500 W ROSEDALE ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-7403
Country : US
Telephone Number : 682-885-6726
Fax Number : 682-885-6729
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2006
Last Update Date : 01/29/2015

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