Provider Demographics
NPI:1487988424
Name:LISA GORN, D.O., P.A.
Entity type:Organization
Organization Name:LISA GORN, D.O., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:512-571-2223
Mailing Address - Street 1:3701 EXECUTIVE CENTER DRIVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731
Mailing Address - Country:US
Mailing Address - Phone:877-278-3690
Mailing Address - Fax:512-494-5300
Practice Address - Street 1:3701 EXECUTIVE CENTER DRIVE
Practice Address - Street 2:SUITE 211
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731
Practice Address - Country:US
Practice Address - Phone:877-278-3690
Practice Address - Fax:512-494-5300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3687174400000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty