Provider Demographics
NPI:1487077723
Name:LACORE, LISA ROUGRAFF (PA-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ROUGRAFF
Last Name:LACORE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:ROUGRAFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1912 HAVERSHAM DRIVE
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022
Mailing Address - Country:US
Mailing Address - Phone:972-345-2445
Mailing Address - Fax:972-378-6749
Practice Address - Street 1:3901 W. 15TH STREET
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075
Practice Address - Country:US
Practice Address - Phone:972-345-2445
Practice Address - Fax:972-378-6749
Is Sole Proprietor?:No
Enumeration Date:2014-01-22
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant