MEDICARE: DR. LISA R RENDON 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
1	207XS0106X	Orthopaedic Hand Surgery Physician	M9105	ID

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	:	1528049178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA R RENDON M.D.

Provider Business Mailing Address
First Line	:	3381 W BAVARIA ST
Second Line	:
City	:	EAGLE
State	:	ID
Zip	:	83616-5341
Country	:	US
Telephone Number	:	208-287-1110
Fax Number	:	208-639-4801

Provider Business Practice Location Address
First Line	:	3381 W BAVARIA ST
Second Line	:
City	:	EAGLE
State	:	ID
Zip	:	83616-5341
Country	:	US
Telephone Number	:	208-287-1110
Fax Number	:	208-639-4801

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

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	05/22/2012

Similar Medicare Providers

1629074158 — DR. VIPUL N NANAVATI MD, BSME, CAQH
Practice Location Address:

3381 W BAVARIA ST
EAGLE, ID
83616-5341

Practice Phone: 208-639-4800
Practice Fax: 208-639-4801

1811978778 — DR. CARL SCOTT HUMPHREY MD
Practice Location Address:

3381 W BAVARIA STREET
EAGLE, ID
83616-5341

Practice Phone: 208-639-4800
Practice Fax: 208-639-4801

1760581409 — BOISE SHOULDER CLINIC, PA
Practice Location Address:

3381 W BAVARIA STREET
EAGLE, ID
83616-5341

Practice Phone: 208-639-4800
Practice Fax: 208-639-4801

1609230374 — CHRISTI E FRANKS FNP-BC
Practice Location Address:

3381 W BAVARIA ST
EAGLE, ID
83616-5341

Practice Phone: 208-639-4800
Practice Fax:

1417167008 — BLUE CELINE STOEHR MA
Practice Location Address:

1065 E WINDING CREEK DR
EAGLE, ID
83616-7243

Practice Phone: 747-229-4299
Practice Fax:

1699617266 — KELSEY MOREY FNP-C
Practice Location Address:

219 S WOODDALE AVE
EAGLE, ID
83616-7714

Practice Phone: 208-994-5575
Practice Fax:

Directions to “ DR. LISA R RENDON M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.