1730201138 NPI number — MS. LISA MARIE ROY M.D.

Table of content: MS. LISA MARIE ROY M.D. (NPI 1730201138)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730201138 NPI number — MS. LISA MARIE ROY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROY
Provider First Name:
LISA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOROCK
Provider Other First Name:
LISA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730201138
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1014 E HIGHWAY 82
Provider Second Line Business Mailing Address:
SUITE 134
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76240-2721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-665-6967
Provider Business Mailing Address Fax Number:
469-759-1976

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
314 N GRAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76240-4322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-665-6967
Provider Business Practice Location Address Fax Number:
888-292-0671
Provider Enumeration Date:
04/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  M0892 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1794679-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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