Provider Demographics
NPI:1053571356
Name:LISA R HEARING MD PA
Entity type:Organization
Organization Name:LISA R HEARING MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HEARING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-744-8319
Mailing Address - Street 1:3893 MILITARY TRL
Mailing Address - Street 2:1
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2936
Mailing Address - Country:US
Mailing Address - Phone:561-744-8319
Mailing Address - Fax:561-744-6607
Practice Address - Street 1:3893 MILITARY TRL
Practice Address - Street 2:1
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2936
Practice Address - Country:US
Practice Address - Phone:561-744-8319
Practice Address - Fax:561-744-6607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65733174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G33263Medicare UPIN
28888AMedicare PIN