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NPI Code Detail

MEDICARE: LISA NICOLE ANDERSON MD

MEDICARE: LISA NICOLE ANDERSON 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
12086X0206XSurgical Oncology Physician35.149055OH
2390200000XStudent in an Organized Health Care Education/Training Program664589TX
32086X0206XSurgical Oncology PhysicianV2686TX

General Provider Information

NPI Number : 1992226021
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA NICOLE ANDERSON MD
Provider Business Mailing Address
First Line : 7777 FOREST LN STE C614
Second Line :
City : DALLAS
State : TX
Zip : 75230-6856
Country : US
Telephone Number : 972-566-7499
Fax Number : 972-566-6428
Provider Business Practice Location Address
First Line : 7777 FOREST LN STE C614
Second Line :
City : DALLAS
State : TX
Zip : 75230-6856
Country : US
Telephone Number : 972-566-7499
Fax Number : 972-566-6428
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2017
Last Update Date : 02/19/2025

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