Provider Demographics
NPI:1285778670
Name:BARRETT, LISA S (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:S
Last Name:BARRETT
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 1:5833 VIA CUESTA DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-6610
Mailing Address - Country:US
Mailing Address - Phone:915-539-7841
Mailing Address - Fax:
Practice Address - Street 1:210 THUNDERBIRD DR STE T
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-3910
Practice Address - Country:US
Practice Address - Phone:915-300-0287
Practice Address - Fax:915-314-0474
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.096055208100000X
TXQ7639208100000X
NMMD2020-0734208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810018857Medicaid
NM23738839Medicaid
OH3100996Medicaid
OHP00877476OtherRRMCR
OH7420591OtherMCR
OH4305841OtherMCR
OH000000679326OtherANTHEM
TX391322001Medicaid