Provider Demographics
NPI:1063495661
Name:ROUSE, LISA A (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:A
Last Name:ROUSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:707 HILL COUNTRY DR,
Mailing Address - Street 2:#106
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-5910
Mailing Address - Country:US
Mailing Address - Phone:830-896-0404
Mailing Address - Fax:830-896-4343
Practice Address - Street 1:707 HILL COUNTRY DR,
Practice Address - Street 2:#106
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5910
Practice Address - Country:US
Practice Address - Phone:830-896-0404
Practice Address - Fax:830-896-4343
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2008-01-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXH3937207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE84792Medicare UPIN
TX8459N1Medicare PIN