Provider Demographics
NPI:1295938629
Name:SATHRE, LISA LINETTE (MD)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LINETTE
Last Name:SATHRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:LINETTE
Other - Last Name:LANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4930 N 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5615
Mailing Address - Country:US
Mailing Address - Phone:520-577-3333
Mailing Address - Fax:520-577-4685
Practice Address - Street 1:4930 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-5615
Practice Address - Country:US
Practice Address - Phone:520-577-3333
Practice Address - Fax:520-577-4685
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ40475208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ355175Medicaid