Provider Demographics
NPI:1073826442
Name:JEMISON, LIZA (MD)
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:
Last Name:JEMISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1330 KINGWOOD DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-3038
Mailing Address - Country:US
Mailing Address - Phone:281-348-7301
Mailing Address - Fax:281-348-2186
Practice Address - Street 1:1330 KINGWOOD DR
Practice Address - Street 2:SUITE 200
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-3038
Practice Address - Country:US
Practice Address - Phone:281-348-7301
Practice Address - Fax:281-348-2186
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXBP10037630207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine