Provider Demographics
NPI:1609883701
Name:ABBOTT, LISA G (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:G
Last Name:ABBOTT
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 1:665 SIERRA ROSE DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2060
Mailing Address - Country:US
Mailing Address - Phone:775-786-6770
Mailing Address - Fax:775-786-4901
Practice Address - Street 1:665 SIERRA ROSE DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2060
Practice Address - Country:US
Practice Address - Phone:775-786-6770
Practice Address - Fax:775-786-4901
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6743207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
880323773OtherTAX ID NUMBER
V30019Medicare ID - Type Unspecified