Provider Demographics
NPI:1891113189
Name:GISCOMBE, LISA-GAYE (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA-GAYE
Middle Name:
Last Name:GISCOMBE
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 1:3661 S MIAMI AVE STE 301A
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4232
Mailing Address - Country:US
Mailing Address - Phone:561-548-1542
Mailing Address - Fax:
Practice Address - Street 1:3661 S MIAMI AVE STE 301A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4232
Practice Address - Country:US
Practice Address - Phone:561-548-1542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL390200000X
FLME143794207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program