Provider Demographics
NPI:1295909406
Name:GAVIN, LISA DEFRANCO (MD, MPH)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:DEFRANCO
Last Name:GAVIN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:DEFRANCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1704 PINTO LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1704 PINTO LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4102
Practice Address - Country:US
Practice Address - Phone:702-455-3210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13249207ZF0201X
NMMD2008-0361207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology