Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 7498 | AZ |
NPI | 1023133964 |
---|---|
Provider Name | Lisa M Poormon |
First Address | Avondale, AZ 85392-5007 |
Second Address | Avondale, AZ 85392-5007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 07/01/2008 |