Brandy, Lisa J

Brandy, Lisa J is an individual health care provider with primary practice located at 1801 N. Hampton Rd Ste 340, Desoto TX 75115-8317. She recently has 2 registered licenses in different health care specialties including Podiatric Medicine & Surgery Service Providers / Podiatrist, Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery. Podiatric Medicine & Surgery Service Providers / Podiatrist is her primary health care specialty. Brandy, Lisa J can be contacted via phone (972) 293-9650.

Contact Information

Primary practice address
1801 N. Hampton Rd Ste 340 Desoto TX 75115-8317
Phone: (972) 293-9650
Fax: (972) 291-2533
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X 1204 Texas
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X 1204 Texas

Profile Details

NPI number 1336115963
LBN Legal business name Brandy, Lisa J
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 24th, 2006
Last updated Jan 27th, 2017 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1336115963 NPPES
Texas Other 8V8260 BLUE SHIELD
Texas MEDICAID 136477012 BLUE SHIELD

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