Provider Demographics
NPI:1669508735
Name:DEYERLE, LISA MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MICHELLE
Last Name:DEYERLE
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Gender:F
Credentials:MD
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Mailing Address - Street 1:2000 HEALTH PARK DR FL HP2
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4525
Mailing Address - Country:US
Mailing Address - Phone:615-373-7600
Mailing Address - Fax:877-767-2310
Practice Address - Street 1:4901 BRAMBLETON AVE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-4149
Practice Address - Country:US
Practice Address - Phone:540-777-4000
Practice Address - Fax:540-777-4007
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2019-10-30
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Provider Licenses
StateLicense IDTaxonomies
VA0101234624207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I07901Medicare UPIN