Provider Demographics
NPI:1043422744
Name:HAUBERT, LISA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:HAUBERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6560 FANNIN ST
Mailing Address - Street 2:SUITE 1404
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2761
Mailing Address - Country:US
Mailing Address - Phone:713-790-0600
Mailing Address - Fax:713-790-0616
Practice Address - Street 1:6560 FANNIN ST
Practice Address - Street 2:SUITE 1404
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2761
Practice Address - Country:US
Practice Address - Phone:713-790-0600
Practice Address - Fax:713-790-0616
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH57.011741208600000X
TXP7927208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8FG853OtherBLUE CROSS BLUE SHIELD
TX320911YMVQMedicare PIN