Provider Demographics
NPI:1083642243
Name:FERREIRA, LISA ANNE (DO)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE
Last Name:FERREIRA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5205 GREENWOOD AVE
Mailing Address - Street 2:STE 251
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2400
Mailing Address - Country:US
Mailing Address - Phone:561-844-6605
Mailing Address - Fax:561-848-9059
Practice Address - Street 1:5205 GREENWOOD AVE
Practice Address - Street 2:STE 251
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2400
Practice Address - Country:US
Practice Address - Phone:561-844-6605
Practice Address - Fax:561-848-9059
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8637208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2639572Medicaid
G05951Medicare UPIN