Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 234654 | MA |
N | 111NI0900X | Internist | 234654 | MA |
N | 207R00000X | Internist | 43169 | TN |
N | 111NI0900X | Internist | 43169 | TN |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 0000043169 | TN |
N | 207RE0101X | Endocrinologist (Diabetes Doctor) | 43169 | TN |
NPI | 1053597674 |
---|---|
Provider Name | Dr. Lisa Suzanne Usdan |
First Address | Memphis, TN 38119 |
Second Address | Memphis, TN 38120 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2008 |
Last Update Date | 18/07/2014 |