Provider Demographics
NPI:1639331200
Name:MATHEW, LISA K (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:MATHEW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3911 AMBROSIA ST STE 201
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-3888
Mailing Address - Country:US
Mailing Address - Phone:303-788-8888
Mailing Address - Fax:844-347-5158
Practice Address - Street 1:3911 AMBROSIA ST STE 201
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-3888
Practice Address - Country:US
Practice Address - Phone:303-788-8888
Practice Address - Fax:844-347-5158
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CODR.0054046207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology