Provider Demographics
NPI:1346245818
Name:LISSE, SCOTT ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ANTHONY
Last Name:LISSE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4543 POST OAK PLACE DRIVE
Mailing Address - Street 2:STE 105
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027
Mailing Address - Country:US
Mailing Address - Phone:713-797-1087
Mailing Address - Fax:713-797-9814
Practice Address - Street 1:4543 POST OAK PLACE DRIVE
Practice Address - Street 2:STE 105
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027
Practice Address - Country:US
Practice Address - Phone:713-797-1087
Practice Address - Fax:713-797-9814
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2012-08-09
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Provider Licenses
StateLicense IDTaxonomies
TXH8118207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF26647Medicare UPIN