Provider Demographics
NPI:1558707323
Name:LISA J LEARN, D.O., PA
Entity Type:Organization
Organization Name:LISA J LEARN, D.O., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEARN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-380-8411
Mailing Address - Street 1:4900 WEST OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313-1583
Mailing Address - Country:US
Mailing Address - Phone:954-380-8411
Mailing Address - Fax:954-380-8413
Practice Address - Street 1:4900 WEST OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-1583
Practice Address - Country:US
Practice Address - Phone:954-380-8411
Practice Address - Fax:954-380-8413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-20
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11699208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG45569Medicare UPIN