Provider Demographics
NPI:1245347889
Name:LEARN, LISA J (DO)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:J
Last Name:LEARN
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:3536 N FEDERAL HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-6264
Mailing Address - Country:US
Mailing Address - Phone:954-380-8411
Mailing Address - Fax:954-380-8413
Practice Address - Street 1:4900 WEST OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-1583
Practice Address - Country:US
Practice Address - Phone:954-380-8411
Practice Address - Fax:954-380-8413
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2024-03-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PA0510546L208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50051231OtherCAPITAL BLUE CROSS
PA1323204OtherBLUE SHIELD
PA1520006OtherGATEWAY
PA7128289OtherAETNA
PA0018732010004Medicaid
PAG45569Medicare UPIN
PA1323204OtherBLUE SHIELD