Provider Demographics
NPI:1467402255
Name:MASSEY, LISA G (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:G
Last Name:MASSEY
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 1:420 WATER ST #105-B
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028
Mailing Address - Country:US
Mailing Address - Phone:830-896-1344
Mailing Address - Fax:830-896-1363
Practice Address - Street 1:420 WATER ST #105-B
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028
Practice Address - Country:US
Practice Address - Phone:830-896-1344
Practice Address - Fax:830-896-1363
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1473207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128706203Medicaid
TX87K591Medicare PIN
TXC18923Medicare UPIN