Provider Demographics
NPI:1740453976
Name:LISA D TAYLOR MD PC
Entity type:Organization
Organization Name:LISA D TAYLOR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATION SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:HART
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-751-1321
Mailing Address - Street 1:4514 W MEMORIAL CIR
Mailing Address - Street 2:SUITE B
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142
Mailing Address - Country:US
Mailing Address - Phone:405-751-1321
Mailing Address - Fax:
Practice Address - Street 1:4514 MEMORIAL CIR
Practice Address - Street 2:SUITE B
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-5000
Practice Address - Country:US
Practice Address - Phone:405-751-1321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK178652086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKF37302Medicare UPIN