MEDICARE: DR. LISA M JAUBERT MD

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
1	208100000X	Physical Medicine & Rehabilitation Physician	203313	LA
2	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	203313	LA
3	208VP0014X	Interventional Pain Medicine Physician	203313	LA

Other Identifiers

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

General Provider Information

NPI Number	:	1144410796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA M JAUBERT MD

Provider Business Mailing Address
First Line	:	1200 PINNACLE PKWY STE 7
Second Line	:
City	:	COVINGTON
State	:	LA
Zip	:	70433-9169
Country	:	US
Telephone Number	:	985-807-1919
Fax Number	:	985-807-1918

Provider Business Practice Location Address
First Line	:	1200 PINNACLE PKWY STE 7
Second Line	:
City	:	COVINGTON
State	:	LA
Zip	:	70433-9169
Country	:	US
Telephone Number	:	985-643-4144
Fax Number	:	985-643-3603

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2007
Last Update Date	:	12/09/2022

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