Provider Demographics
NPI:1992797450
Name:YORK, LISA MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:YORK
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:PO BOX 409
Mailing Address - Street 2:
Mailing Address - City:PINE
Mailing Address - State:AZ
Mailing Address - Zip Code:85544-0409
Mailing Address - Country:US
Mailing Address - Phone:928-476-3258
Mailing Address - Fax:928-476-3186
Practice Address - Street 1:6152 HARDSCRABBLE ROAD
Practice Address - Street 2:
Practice Address - City:PINE
Practice Address - State:AZ
Practice Address - Zip Code:85544
Practice Address - Country:US
Practice Address - Phone:928-476-3258
Practice Address - Fax:928-476-3186
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24012207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ391186Medicaid
AZAZ0740060OtherBLUE CROSS BLUE SHIELD
AZ1Z9017OtherHEALTHNET
AZ391186Medicaid
AZG60749Medicare UPIN