Provider Demographics
NPI:1093039703
Name:LIESA HARTE, MD, PLLC
Entity Type:Organization
Organization Name:LIESA HARTE, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIESA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-494-4304
Mailing Address - Street 1:1132 S LAMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-2300
Mailing Address - Country:US
Mailing Address - Phone:512-494-4304
Mailing Address - Fax:
Practice Address - Street 1:1132 S LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-2300
Practice Address - Country:US
Practice Address - Phone:512-494-4304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-24
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5545207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty