Provider Demographics
NPI:1184683492
Name:GO, LISA J (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:J
Last Name:GO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:6704 SPRINGWOOD CT
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-8767
Mailing Address - Country:US
Mailing Address - Phone:254-939-3202
Mailing Address - Fax:254-939-3216
Practice Address - Street 1:6704 SPRINGWOOD CT
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-8767
Practice Address - Country:US
Practice Address - Phone:254-939-3202
Practice Address - Fax:254-939-3216
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2908207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87198NOtherBLUE SHIELD
TX110211239OtherRR/MEDICARE
TX1053746-01OtherCSHCN
TX1053746-02Medicaid
TX87198NOtherBLUE SHIELD
TXG93830Medicare UPIN