Provider Demographics
NPI:1538118088
Name:HOOPER, LISA D (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:D
Last Name:HOOPER
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 1:1820 PRESTON PARK BLVD
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-3656
Mailing Address - Country:US
Mailing Address - Phone:972-867-7862
Mailing Address - Fax:972-612-1623
Practice Address - Street 1:1820 PRESTON PARK BLVD
Practice Address - Street 2:SUITE 1200
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-3656
Practice Address - Country:US
Practice Address - Phone:972-867-7862
Practice Address - Fax:972-612-1623
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9511174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX037288004Medicaid
TX037288005Medicaid
TX89851RMedicare PIN
TXG27482Medicare UPIN
TX037288004Medicaid
TX037288005Medicaid