Provider Demographics
NPI:1760468763
Name:PERDUE, LISA (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:PERDUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:PERDUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1510 N HAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-8301
Mailing Address - Country:US
Mailing Address - Phone:214-686-0435
Mailing Address - Fax:972-291-7409
Practice Address - Street 1:1510 N HAMPTON RD
Practice Address - Street 2:#240
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-8301
Practice Address - Country:US
Practice Address - Phone:214-686-0435
Practice Address - Fax:972-291-7409
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ02442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G0594Medicare PIN