Provider Demographics
NPI:1992768204
Name:MYERS, LISA M (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:MYERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1920 KIRBY PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3654
Mailing Address - Country:US
Mailing Address - Phone:901-334-5464
Mailing Address - Fax:901-334-5466
Practice Address - Street 1:1920 KIRBY PKWY STE 102
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3654
Practice Address - Country:US
Practice Address - Phone:901-334-5464
Practice Address - Fax:901-334-5466
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN20897207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP01073802OtherRAILROAD MEDICARE
TN4327374OtherBCBS
TN4327374OtherBCBS
TNF77539Medicare UPIN