Lisa G. Distefano M.D.

NPI 1003810789 - Pediatrics - 208000000X

NPI Details
NPI 1003810789
Gender Female
Enumeration Date 06/09/2005
Last Updated 11/09/2012
Entity Type Individual
Active Over 11 years ago
Practice Location
2016 S MAIN ST
MARYVILLE MO, 64468-2655, US
Phone (660) 562-2525
Fax (660) 562-7993
Business Location
114 E SOUTH HILLS DR
MARYVILLE MO, 64468-2659, US
Phone (660) 562-2525
Fax (660) 562-4303
Toxanomy
Taxonomy Code 208000000X
License State Missouri
License Number 119536
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According to our database, Dr. Lisa G. Distefano M.D. NPI is 1003810789, taxonomy code is 208000000X and license number is 119536, license state is located at Missouri. Lisa G. Distefano M.D. physically located at 2016 S Main St, Maryville MO, 64468-2655. NPI Number Lisa G. Distefano M.D. has the Individual type.

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1003810789 NPI number is provided on an as is basis without warranty of any kind. 1003810789 is maintained by the National Plan & Provider Enumeration System. The contents of Lisa G. Distefano M.D. are for informational purposes only.