Provider Demographics
NPI:1568410975
Name:DIX EMPERADOR, LISA M (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:DIX EMPERADOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:597 W SESAME DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-7962
Mailing Address - Country:US
Mailing Address - Phone:956-412-7503
Mailing Address - Fax:956-423-0914
Practice Address - Street 1:18414 US HWY 281 N SUITE 104
Practice Address - Street 2:SUITE A
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259
Practice Address - Country:US
Practice Address - Phone:877-460-5004
Practice Address - Fax:888-388-4339
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL3283207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1505398-02Medicaid
TX0035HKOtherBCBS
TX060068750OtherRAILROAD MEDICARE
TX1505398-01Medicaid
TX1505398-03Medicaid
TX0039RAOtherBCBS
TX1757668-01Medicaid
TX8AW384OtherBCBS
TX1757668-01Medicaid
TX1505398-03Medicaid
TX1505398-02Medicaid