Provider Demographics
NPI:1750354007
Name:MARTIN, LISA P (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:P
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 21850
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71903-1850
Mailing Address - Country:US
Mailing Address - Phone:870-285-3118
Mailing Address - Fax:870-285-2759
Practice Address - Street 1:319 E 13TH ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:AR
Practice Address - Zip Code:71958-9541
Practice Address - Country:US
Practice Address - Phone:870-285-3118
Practice Address - Fax:870-285-2759
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9797207Q00000X
ARE-6526207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR185375001Medicaid
AR185375001Medicaid
AR185375001Medicaid