Fairweather, Lisa Diane
Fairweather, Lisa Diane is an sole proprietor health care provider with primary practice located at 5601 Bridge St. #324, Ft. Worth TX 76112. She recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as her primary health care specialty. Fairweather, Lisa Diane can be contacted via phone (817) 457-4646.Contact Information
Primary practice address
5601 Bridge St. #324
Ft. Worth TX 76112
Phone: (817) 457-4646
Fax: (817) 492-7135
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Psychiatry | 2084P0800X | L6256 | Texas |
Profile Details
| NPI number | 1720031404 |
|---|---|
| LBN Legal business name | Fairweather, Lisa Diane |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 17th, 2006 |
| Last updated | Oct 14th, 2010 - about 14 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1720031404 | NPPES |
| Texas | MEDICAID | 175470702 |
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