Provider Demographics
NPI:1174657191
Name:FLORENCE, LISA ALISON (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:ALISON
Last Name:FLORENCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1602 HIGHWAY 77
Mailing Address - Street 2:
Mailing Address - City:SOUTHSIDE
Mailing Address - State:AL
Mailing Address - Zip Code:35907-0100
Mailing Address - Country:US
Mailing Address - Phone:256-295-4390
Mailing Address - Fax:256-442-6762
Practice Address - Street 1:1602 HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:SOUTHSIDE
Practice Address - State:AL
Practice Address - Zip Code:35907-0100
Practice Address - Country:US
Practice Address - Phone:256-295-4390
Practice Address - Fax:256-442-6762
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO.920207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine