Provider Demographics
NPI:1336115963
Name:BRANDY, LISA J (DPM)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:J
Last Name:BRANDY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:445 E FM 1382
Mailing Address - Street 2:#3-111
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-6047
Mailing Address - Country:US
Mailing Address - Phone:972-293-9650
Mailing Address - Fax:972-291-2533
Practice Address - Street 1:1801 N. HAMPTON RD
Practice Address - Street 2:STE 340
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-8317
Practice Address - Country:US
Practice Address - Phone:972-293-9650
Practice Address - Fax:972-291-2533
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1204213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8V8260OtherBLUE SHIELD
TX136477012Medicaid
TX136477012Medicaid
TXU34081Medicare UPIN