Provider Demographics
NPI:1912408170
Name:JOHANNESSON, LIZA (MD PHD)
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:
Last Name:JOHANNESSON
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BAYLOR UNIVERSITY MEDICAL CENTER, 3410 WORTH STREET
Mailing Address - Street 2:STE 950
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246
Mailing Address - Country:US
Mailing Address - Phone:214-820-6983
Mailing Address - Fax:214-818-6491
Practice Address - Street 1:BAYLOR UNIVERSITY MEDICAL CENTER, 3410 WORTH STREET
Practice Address - Street 2:STE 950
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246
Practice Address - Country:US
Practice Address - Phone:214-820-6983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX46229204F00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery