Provider Demographics
NPI:1225296239
Name:LISA L SWANSON MD DBA MESQUITE PEDIATRIC ASSOCIATES
Entity Type:Organization
Organization Name:LISA L SWANSON MD DBA MESQUITE PEDIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-613-3883
Mailing Address - Street 1:3220 GUS THOMASSON RD STE 350
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-4051
Mailing Address - Country:US
Mailing Address - Phone:972-613-3883
Mailing Address - Fax:972-686-7981
Practice Address - Street 1:3220 GUS THOMASSON RD STE 350
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4051
Practice Address - Country:US
Practice Address - Phone:972-613-3883
Practice Address - Fax:972-686-7981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0867208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty