Provider Demographics
NPI:1790910701
Name:HERZIG, LISA DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:DIANE
Last Name:HERZIG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4800 SAND POINT WAY NE
Mailing Address - Street 2:M/S OC.9.840
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3901
Mailing Address - Country:US
Mailing Address - Phone:206-987-2210
Mailing Address - Fax:206-987-3824
Practice Address - Street 1:2600 NE NEFF RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6337
Practice Address - Country:US
Practice Address - Phone:541-706-6843
Practice Address - Fax:541-598-3444
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
WAMD602721172080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program