Provider Demographics
NPI:1609990993
Name:LISKEY, LEE ROY (MD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:ROY
Last Name:LISKEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2480 MISSION ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-2468
Mailing Address - Country:US
Mailing Address - Phone:415-642-2000
Mailing Address - Fax:415-642-0621
Practice Address - Street 1:2480 MISSION ST
Practice Address - Street 2:SUITE 108
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2468
Practice Address - Country:US
Practice Address - Phone:415-642-2000
Practice Address - Fax:415-642-0621
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA48467207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA943268785Medicaid
CAA48467OtherMEDICAL BOARD OF CALIFORNIA
CAF30897Medicare UPIN