Provider Demographics
NPI:1275604340
Name:FALLS, LISA LYNNETTE (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:LYNNETTE
Last Name:FALLS
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 1:1600 PROVIDENCE DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76707-2261
Mailing Address - Country:US
Mailing Address - Phone:254-313-4200
Mailing Address - Fax:254-313-4326
Practice Address - Street 1:1600 PROVIDENCE DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76707-2261
Practice Address - Country:US
Practice Address - Phone:254-313-4200
Practice Address - Fax:254-313-4531
Is Sole Proprietor?:No
Enumeration Date:2006-11-12
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK81412084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX040503701Medicaid
TX040503702Medicaid
TX88971GOtherBLUE CROSS BLUE SHIELD
TX8248J0Medicare ID - Type UnspecifiedPROVIDER NUMBER
TX88971GOtherBLUE CROSS BLUE SHIELD
TX260041727Medicare ID - Type UnspecifiedRAIL ROAD MEDICARE
TX040503701Medicaid