Provider Demographics
NPI:1932368487
Name:LISA A PERRYMAN MD PC
Entity Type:Organization
Organization Name:LISA A PERRYMAN MD PC
Other - Org Name:LISA A ZURAFF-PERRYMAN MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZURAFF-PERRYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-840-8822
Mailing Address - Street 1:10940 S PARKER RD
Mailing Address - Street 2:NO 805
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-7440
Mailing Address - Country:US
Mailing Address - Phone:303-805-4470
Mailing Address - Fax:303-840-0551
Practice Address - Street 1:9397 CROWN CREST BLVD
Practice Address - Street 2:STE 301
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8575
Practice Address - Country:US
Practice Address - Phone:303-840-8822
Practice Address - Fax:303-840-8824
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LISA A PERRYMAN MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-09
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37199208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOB4076Medicare PIN
COCO40080Medicare PIN