Provider Demographics
NPI:1720249469
Name:THALHEIMER, LIZA OPPER (MD)
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:OPPER
Last Name:THALHEIMER
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-0813
Practice Address - Street 1:13215 DOTSON RD STE 170B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4535
Practice Address - Country:US
Practice Address - Phone:281-671-5877
Practice Address - Fax:832-601-6448
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXR03342086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5094880OtherAETNA
TX8GG808OtherBCBS
TX2G7477Medicaid