Provider Demographics
NPI:1710391727
Name:SHUMATE, LISA W (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:W
Last Name:SHUMATE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:KATHLEEN
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:760 N DENTON TAP RD STE 120
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2164
Mailing Address - Country:US
Mailing Address - Phone:972-420-1475
Mailing Address - Fax:
Practice Address - Street 1:760 N DENTON TAP RD STE 120
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019
Practice Address - Country:US
Practice Address - Phone:972-420-1475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK30781208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics