Provider Demographics
NPI:1083683569
Name:MATSON, LISA SCHEYER (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:SCHEYER
Last Name:MATSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 W WILLOW RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-2531
Mailing Address - Country:US
Mailing Address - Phone:580-237-4100
Mailing Address - Fax:580-237-4109
Practice Address - Street 1:1204 W WILLOW RD
Practice Address - Street 2:SUITE B
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-2531
Practice Address - Country:US
Practice Address - Phone:580-237-4100
Practice Address - Fax:580-237-4109
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK237952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200047970AMedicaid
I27938Medicare UPIN
233511800Medicare ID - Type Unspecified