Provider Demographics
NPI:1588681241
Name:OAKLEY, LISA M (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:OAKLEY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:CB 8131
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-7200
Mailing Address - Fax:314-747-4189
Practice Address - Street 1:510 S KINGSHIGHWAY BLVD
Practice Address - Street 2:DEPT RADIOLOGY
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1016
Practice Address - Country:US
Practice Address - Phone:314-362-7200
Practice Address - Fax:314-747-4189
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-11-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO1133802085R0202X
IL0360968032085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209787605Medicaid
MO209787605Medicaid
G73715OtherUPIN
P00053305OtherRR CARE
012013128OtherMO CARE
1390OtherMO BLUE
209787605OtherMO CAID
300084325OtherRR CARE
431725842MIDOtherMERCY
028012444OtherMO CARE
131675OtherBLUE CHOICE
13258OtherHCARE USA
2781OtherGHP
405300OtherH LINK
012013128OtherCARE
028012444OtherCARE
G73715OtherUPIN
13258OtherHCARE USA