Provider Demographics
NPI:1205807500
Name:BARKER, LISA WAGGONER (MD)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:WAGGONER
Last Name:BARKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:WAGGONER
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2061 COLLIER PKWY
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-5202
Mailing Address - Country:US
Mailing Address - Phone:727-845-5707
Mailing Address - Fax:813-501-8250
Practice Address - Street 1:2061 COLLIER PKWY
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-5202
Practice Address - Country:US
Practice Address - Phone:727-845-5707
Practice Address - Fax:813-501-8250
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30616207Q00000X
FLME1289802086H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086H0002XAllopathic & Osteopathic PhysiciansSurgeryHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000045747OtherBLUE CROSS AND BLUE SHIELD
000000583695OtherBLUE CROSS AND BLUE SHIELD
KY64306160Medicaid
KY1208002Medicare PIN
KY0078002Medicare PIN