Provider Demographics
NPI:1699008409
Name:AVERY, LISA M (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:AVERY
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:PO BOX 16156
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33766
Mailing Address - Country:US
Mailing Address - Phone:727-669-5000
Mailing Address - Fax:727-669-5001
Practice Address - Street 1:34921 US HIGHWAY 19 N
Practice Address - Street 2:SUITE 290
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-1969
Practice Address - Country:US
Practice Address - Phone:727-669-5000
Practice Address - Fax:727-669-5001
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 942262084N0400X, 2084N0600X
GA0534862084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology