Provider Demographics
NPI:1619928652
Name:FERREIRA, LISA M (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:FERREIRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:PHELPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3000 MEDICAL PARK DR STE 490
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-6600
Mailing Address - Country:US
Mailing Address - Phone:813-971-2470
Mailing Address - Fax:813-971-2491
Practice Address - Street 1:3000 MEDICAL PARK DR STE 490
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-6600
Practice Address - Country:US
Practice Address - Phone:813-971-2470
Practice Address - Fax:813-971-2491
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL81913207QB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00149252OtherRAILROAD MEDICARE
FL265057600Medicaid
FLP00149252OtherRAILROAD MEDICARE
FL265057600Medicaid
FL58925YMedicare PIN