Provider Demographics
NPI:1922149798
Name:YOUNG, LISA DYER (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:DYER
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:DAWN
Other - Last Name:DYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2401 VILLAGE PROFESSIONAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-4702
Mailing Address - Country:US
Mailing Address - Phone:334-749-8121
Mailing Address - Fax:334-749-6166
Practice Address - Street 1:2401 VILLAGE PROFESSIONAL DRIVE
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-4702
Practice Address - Country:US
Practice Address - Phone:334-749-8121
Practice Address - Fax:334-749-6166
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21253208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL21253OtherALABAMA CONTR SUBST CERT
36452OtherAMERICAN BOARD PEDIATRICS
AL510-96615OtherBCBS AL PROV # AUBURN
177521OtherAAP ID
AL21253OtherALABAMA MEDICAL LICENSE
AL510-96612OtherBCBS AL PROV # OPELIKA
AL1210778OtherUNITED HEALTH PROV #
AL1210778OtherUNITED HEALTH PROV #
AL510-96612OtherBCBS AL PROV # OPELIKA