Provider Demographics
NPI:1891891305
Name:TAYLOR, LISA DANELE (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:DANELE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4514 MEMORIAL CIR
Mailing Address - Street 2:SUITE B
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-5000
Mailing Address - Country:US
Mailing Address - Phone:405-751-1321
Mailing Address - Fax:405-755-3708
Practice Address - Street 1:4514 MEMORIAL CIR
Practice Address - Street 2:SUITE B
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-5000
Practice Address - Country:US
Practice Address - Phone:405-751-1321
Practice Address - Fax:405-755-3708
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK17865208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
S37302Medicare UPIN
OKF37302Medicare ID - Type Unspecified