Provider Demographics
NPI:1649350026
Name:PATTISON, LISA M (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:PATTISON
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 1:1613 N MCKENZIE ST
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-2247
Mailing Address - Country:US
Mailing Address - Phone:251-949-3710
Mailing Address - Fax:251-949-3715
Practice Address - Street 1:1613 N MCKENZIE ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2247
Practice Address - Country:US
Practice Address - Phone:251-949-3710
Practice Address - Fax:251-949-3715
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.17620207P00000X, 208D00000X, 208M00000X
ALMD17620207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100695480Medicaid
AL194537Medicaid
MS1055764Medicaid
FL1649350026Medicaid
AL515-33171OtherBCBS
AL515-33173OtherBCBS
AL009935959Medicaid
AL1649350026OtherTRICARE SOUTH
AL009935958Medicaid
AL515-33170OtherBCBS
AL009935959Medicaid
AL051533170Medicare PIN