Provider Demographics
NPI:1982699443
Name:ROSS, LISA R (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:R
Last Name:ROSS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1 BROOKINGS DR
Mailing Address - Street 2:CB 1201
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-4862
Mailing Address - Country:US
Mailing Address - Phone:314-935-6666
Mailing Address - Fax:314-935-8515
Practice Address - Street 1:1 BROOKINGS DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-4862
Practice Address - Country:US
Practice Address - Phone:314-935-6666
Practice Address - Fax:314-935-8515
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2019-08-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR7J22207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine