Provider Demographics
NPI:1760749683
Name:BLACKWOOD, LISA ANN (MD, MS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:BLACKWOOD
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:DEININGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 LARK ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-2238
Mailing Address - Country:US
Mailing Address - Phone:504-343-2313
Mailing Address - Fax:
Practice Address - Street 1:3455 S YARROW ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227
Practice Address - Country:US
Practice Address - Phone:303-989-5231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-17
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0060806207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology