Provider Demographics
NPI:1497774020
Name:ELLIS, LISA C (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:C
Last Name:ELLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1301 W 38TH ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1000
Mailing Address - Country:US
Mailing Address - Phone:512-459-9710
Mailing Address - Fax:512-459-9701
Practice Address - Street 1:1301 W 38TH ST
Practice Address - Street 2:SUITE 403
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1000
Practice Address - Country:US
Practice Address - Phone:512-459-9710
Practice Address - Fax:512-459-9701
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH9204207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease