Provider Demographics
NPI:1366535445
Name:HERRIN, LISA J (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:J
Last Name:HERRIN
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 1:14100 SAN PEDRO AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-4363
Mailing Address - Country:US
Mailing Address - Phone:210-981-1975
Mailing Address - Fax:817-568-5474
Practice Address - Street 1:4200 SOUTH FWY STE 100
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76115-1407
Practice Address - Country:US
Practice Address - Phone:817-750-7334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4400207PP0204X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1003887985OtherGRP NPI NUMBER
TX1729016OtherFIRSTHEALTH PIN
TX9057411OtherPHCS PIN
TX140442857Medicaid
TX8M3077OtherBCBSTX IND PIN
TX132731409Medicaid
TX132731411Medicaid
TX6811699OtherCIGNA PIN
TX163314101Medicaid
TX4586688OtherAETNA PIN
TX0087LEOtherBCBSTX GRP PIN
TX163314101Medicaid