Provider Demographics
NPI:1144410796
Name:JAUBERT, LISA M (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:JAUBERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1200 PINNACLE PKWY STE 7
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-9169
Mailing Address - Country:US
Mailing Address - Phone:985-807-1919
Mailing Address - Fax:985-807-1918
Practice Address - Street 1:1200 PINNACLE PKWY STE 7
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-9169
Practice Address - Country:US
Practice Address - Phone:985-643-4144
Practice Address - Fax:985-643-3603
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA203313208100000X, 2081S0010X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1000761Medicaid
LA249682YJXFMedicare PIN