Provider Demographics
NPI:1396770343
Name:HEARING, LISA R (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:R
Last Name:HEARING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 S OLD DIXIE HWY
Mailing Address - Street 2:#303
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7202
Mailing Address - Country:US
Mailing Address - Phone:561-744-8319
Mailing Address - Fax:561-744-6607
Practice Address - Street 1:1002 S OLD DIXIE HWY
Practice Address - Street 2:#303
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7202
Practice Address - Country:US
Practice Address - Phone:561-744-8319
Practice Address - Fax:561-744-6607
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65733174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28888OtherBLUE CROSS
FL28888OtherBLUE CROSS
FLG33263Medicare UPIN