Provider Demographics
NPI:1588056303
Name:LISBOA, COURTNEY ALICE (DO)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:ALICE
Last Name:LISBOA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:COURTNEY
Other - Middle Name:ALICE
Other - Last Name:BARRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10226 COULOAK DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-7675
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10226 COULOAK DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-7675
Practice Address - Country:US
Practice Address - Phone:704-801-7380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-03
Last Update Date:2024-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2023-00628207Q00000X
OH34.012816207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty