Provider Demographics
NPI:1467458984
Name:ZACK, LISA (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ZACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:801 ANCHOR RODE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-2742
Mailing Address - Country:US
Mailing Address - Phone:239-263-1717
Mailing Address - Fax:239-403-9410
Practice Address - Street 1:801 ANCHOR RODE DR
Practice Address - Street 2:STE 100
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-2742
Practice Address - Country:US
Practice Address - Phone:239-263-1717
Practice Address - Fax:239-403-9410
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2020-09-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME56408207N00000X, 207ND0101X, 207NI0002X, 207NP0225X, 207NS0135X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0387142OtherUNITED HEALTHCARE
FL08856OtherBCBS
FLZE2985OtherBCBS MA
FL713505OtherTUFTS
FL568740OtherBCBS PA
FL713505OtherTUFTS
FLC43107Medicare UPIN