Provider Demographics
NPI:1437116126
Name:PERDUE, LISA K (AP)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:K
Last Name:PERDUE
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2298 NW 2ND AVE
Mailing Address - Street 2:SUITE 16
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6764
Mailing Address - Country:US
Mailing Address - Phone:561-603-6910
Mailing Address - Fax:
Practice Address - Street 1:2298 NW 2ND AVE
Practice Address - Street 2:SUITE 16
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6764
Practice Address - Country:US
Practice Address - Phone:561-603-6910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1866171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCOO1FOtherBLUE CROSS BLUE SHIELD