Provider Demographics
NPI:1053328013
Name:MOORE, LISA (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:4600A MONTGOMERY BLVD NE
Mailing Address - Street 2:# 105
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1218
Mailing Address - Country:US
Mailing Address - Phone:877-978-2229
Mailing Address - Fax:505-830-2023
Practice Address - Street 1:4801 ALBERTA AVE
Practice Address - Street 2:DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2707
Practice Address - Country:US
Practice Address - Phone:915-215-5099
Practice Address - Fax:915-545-6946
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2021-02-03
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Provider Licenses
StateLicense IDTaxonomies
NM2003-0491207V00000X
TXQ2026207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology