Provider Demographics
NPI:1629051495
Name:COLUMBIA, LISA DEAN (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DEAN
Last Name:COLUMBIA
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 1:720 MONTCLAIR RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-1964
Mailing Address - Country:US
Mailing Address - Phone:205-591-7246
Mailing Address - Fax:205-591-4420
Practice Address - Street 1:720 MONTCLAIR RD
Practice Address - Street 2:SUITE 204
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-1964
Practice Address - Country:US
Practice Address - Phone:205-591-7246
Practice Address - Fax:205-591-4420
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15305207Q00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALE43124Medicare UPIN