Provider Demographics
NPI:1396914750
Name:JAWAHAR, LISA L (RT(R)(T))
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:L
Last Name:JAWAHAR
Suffix:
Gender:F
Credentials:RT(R)(T)
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10469 PLUM CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-8530
Mailing Address - Country:US
Mailing Address - Phone:318-697-9494
Mailing Address - Fax:
Practice Address - Street 1:510 EAST STONER AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LOUISIANA
Practice Address - Zip Code:71101
Practice Address - Country:UM
Practice Address - Phone:318-990-4963
Practice Address - Fax:405-456-7620
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA56572085R0001X, 2471R0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471R0002XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiation Therapy
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology