Provider Demographics
NPI:1295810570
Name:ALEVIZON, LISA LEE (MD)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LEE
Last Name:ALEVIZON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:567 CORPORATE DRIVE
Mailing Address - Street 2:
Mailing Address - City:HOUME
Mailing Address - State:LA
Mailing Address - Zip Code:70360
Mailing Address - Country:US
Mailing Address - Phone:985-223-3811
Mailing Address - Fax:985-223-3877
Practice Address - Street 1:567 CORPORATE DRIVE
Practice Address - Street 2:
Practice Address - City:HOUME
Practice Address - State:LA
Practice Address - Zip Code:70360
Practice Address - Country:US
Practice Address - Phone:985-223-3811
Practice Address - Fax:985-223-3877
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD023740208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
H33272Medicare UPIN
LA45357CN60Medicare ID - Type Unspecified