Smith, Lisa Mabry

Smith, Lisa Mabry is an individual health care provider with primary practice located at 14257 Dedeaux Rd , Gulfport MS 39503-3369. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Diagnostic Radiology, Student, Health Care / Student in an Organized Health Care Education/Training Program. Allopathic & Osteopathic Physicians / Diagnostic Radiology is her primary health care specialty. Smith, Lisa Mabry can be contacted via phone (228) 314-7226.

Contact Information

Primary practice address
14257 Dedeaux Rd Gulfport MS 39503-3369
Phone: (228) 314-7226
Fax: (228) 314-7227
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 32125 Alabama
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 24862 Mississippi

Profile Details

NPI number 1912298498
LBN Legal business name Smith, Lisa Mabry
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 2nd, 2011
Last updated Mar 17th, 2018 - about 6 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 1912298498 NPPES
Mississippi MEDICAID 00536826
Mississippi Other 568617YSJ9
Mississippi Other 598607
Mississippi Other P01842090

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