Provider Demographics
NPI:1033120399
Name:BUCKMILLER, LISA MCKAY (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MCKAY
Last Name:BUCKMILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-8483
Mailing Address - Fax:682-885-3113
Practice Address - Street 1:901 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2722
Practice Address - Country:US
Practice Address - Phone:682-885-6850
Practice Address - Fax:682-885-6799
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE2549207YP0228X
TXP3862207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology