Provider Demographics
NPI:1740353887
Name:ALTMANN, LISA D (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:D
Last Name:ALTMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1100 ANDRE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-2159
Mailing Address - Country:US
Mailing Address - Phone:337-365-5944
Mailing Address - Fax:337-364-4377
Practice Address - Street 1:1100 ANDRE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2159
Practice Address - Country:US
Practice Address - Phone:337-365-5944
Practice Address - Fax:337-364-4377
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.021583207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1538400Medicaid
LAP00455381OtherRAILROAD MEDICARE
LAP00455381OtherRAILROAD MEDICARE
G27215Medicare UPIN
LA1538400Medicaid