Provider Demographics
NPI:1821218637
Name:SCHROCK, LISA MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:SCHROCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:DOUTHIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1465 SOUTH GRAND BLVD. SSM GLENNON CARE -
Mailing Address - Street 2:CARDINAL GLENNON CHILDREN'S MEDICAL CENTER
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-1095
Mailing Address - Country:US
Mailing Address - Phone:314-577-5600
Mailing Address - Fax:
Practice Address - Street 1:1465 SOUTH GRAND BLVD. SSM GLENNON CARE -
Practice Address - Street 2:CARDINAL GLENNON CHILDREN'S MEDICAL CENTER
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1095
Practice Address - Country:US
Practice Address - Phone:314-577-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO102917208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics