Provider Demographics
NPI:1558451641
Name:DEWITT, LISA JANE (DO)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:JANE
Last Name:DEWITT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 57TH ST N
Mailing Address - Street 2:BUILDING #1
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35217-3328
Mailing Address - Country:US
Mailing Address - Phone:205-808-3706
Mailing Address - Fax:
Practice Address - Street 1:6500 FLOTILLA DR
Practice Address - Street 2:
Practice Address - City:HOLMES BEACH
Practice Address - State:FL
Practice Address - Zip Code:34217-1464
Practice Address - Country:US
Practice Address - Phone:941-778-3525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0007033207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine