Provider Demographics
NPI:1023038502
Name:GENECOV, LISA W (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:W
Last Name:GENECOV
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Gender:F
Credentials:MD
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Mailing Address - Street 1:7777 FOREST LN
Mailing Address - Street 2:SUITE B 326
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2505
Mailing Address - Country:US
Mailing Address - Phone:972-566-8466
Mailing Address - Fax:972-566-8329
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:SUITE B 326
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2505
Practice Address - Country:US
Practice Address - Phone:972-566-8466
Practice Address - Fax:972-566-8329
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
TXH80682080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF31692Medicare UPIN