Provider Demographics
NPI:1346291192
Name:MARR, LISA A (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:A
Last Name:MARR
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:UNIVERSITY OF NEW MEXICO UNM PALLIATIVE CARE OFC
Mailing Address - Street 2:MSC 11 6020, 1 UNIVERSITY OF NEW MEXICO
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-272-4868
Mailing Address - Fax:515-272-8572
Practice Address - Street 1:UNIVERSITY OF NEW MEXICO UNM PALLIATIVE CARE OFC
Practice Address - Street 2:MSC 11 6020, 1 UNIVERSITY OF NEW MEXICO
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-4868
Practice Address - Fax:505-272-8572
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2008-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2008-0589207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000009652WOtherHUMANA
WI34416700Medicaid
WI34416700Medicaid
000009652WOtherHUMANA