Provider Demographics
NPI:1750688800
Name:MARK, LISA (MDMPHFACOG)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:MARK
Suffix:
Gender:F
Credentials:MDMPHFACOG
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1890 SW HEALTH PKWY STE 205
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-0473
Mailing Address - Country:US
Mailing Address - Phone:239-449-7979
Mailing Address - Fax:239-593-3356
Practice Address - Street 1:1890 SW HEALTH PKWY STE 205
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-0473
Practice Address - Country:US
Practice Address - Phone:239-449-7979
Practice Address - Fax:239-593-3356
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME100791207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology