Provider Demographics
NPI:1528354644
Name:BALL, LISA DAVIS (DO)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:DAVIS
Last Name:BALL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:116 1ST ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3305
Mailing Address - Country:US
Mailing Address - Phone:727-895-5210
Mailing Address - Fax:727-821-4297
Practice Address - Street 1:116 1ST ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3305
Practice Address - Country:US
Practice Address - Phone:727-895-5210
Practice Address - Fax:727-821-4297
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS11961207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012130600Medicaid
FLHV686YMedicare PIN