Provider Demographics
NPI:1295776425
Name:DEGNORE, LISA T (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:T
Last Name:DEGNORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 NICHOLASVILLE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1410
Mailing Address - Country:US
Mailing Address - Phone:859-899-7950
Mailing Address - Fax:859-260-5150
Practice Address - Street 1:1760 NICHOLASVILLE RD STE 101
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1410
Practice Address - Country:US
Practice Address - Phone:859-899-7950
Practice Address - Fax:859-260-5150
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY29499207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4603229OtherAETNA
KY61-0979936OtherTAX ID
KY000000047280OtherBCBS
KY64294994Medicaid
KY4603229OtherAETNA
KY64294994Medicaid