LISA MABRY SMITH (NPI# 1912298498) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912298498 |
| Entity Type | Individual |
| Full Name | LISA MABRY SMITH |
| Credential | MD |
| Practice Address |
14257 Dedeaux Rd Gulfport MS 39503-3369 |
| Mailing Address |
Po Box 10370 Gulfport MS 39505-0370 |
| Practice Telephone | 2283147226 |
| Practice Fax Number | 2283147227 |
| Mailing Telephone | 2283147226 |
| Mailing Fax Number | 2283147227 |
| Enumeration Date | 2011-05-02 |
| Last Update Date | 2018-03-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
24862 | MS | Allopathic & Osteopathic Physicians |
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
32125 | AL | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 00536826 | 05 | |
| MS | BCBS MS | 598607 | 01 |
| MS | RAILROAD MEDICARE | P01842090 | 01 |
| MS | MEDICARE | 568617YSJ9 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 150 Reynoir St, Biloxi, MS 395304130 | 2284321571 | |
| 840 Montclair Rd, Suite 317, Birmingham, AL 352131920 | 2055925135 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124626403 | Lisa Whyeyeh Smith | Early Intervention Provider Agency | 6143 186th St Ste 436, Fresh Meadows, NY 11365-2710 | 2020-10-09 |
| 1982211280 | Lisa Marie Smith | Pharmacist | 5409 S 60th Pl, Rogers, AR 72758-8230 | 2020-09-30 |
| 1710590757 | Lisa M Smith | Occupational Therapy Assistant | 920 Westacre Rd, West Sacramento, CA 95691-3224 | 2020-08-28 |
| 1013531060 | Lisa Marie Smith | Student in an Organized Health Care Education/Training Program | 1465 County Road 232, Collinsville, TX 76233 | 2020-06-05 |
| 1699300350 | Lisa Kathryn Smith | Registered Nurse | 7913 Lakeview Dr, Denver, NC 28037-9265 | 2020-03-03 |
| 1821637778 | Lisa Ann Smith | Dietitian, Registered | 522 10th St, Aplington, IA 50604-1073 | 2019-12-24 |
| 1700421450 | Lisa Marie Smith | Nurse Practitioner | 4353 Heyward St, North Port, FL 34291-4561 | 2019-11-16 |
| 1982168290 | Lisa Lynn Smith | Acupuncturist | 531 Central Park Avenue, Suite 304, Searsdale, NY 10583 | 2019-01-31 |
| 1649753120 | Lisa Lynn Smith | Occupational Therapist | 355 Dogwood South Ln, Haughton, LA 71037-8511 | 2018-09-11 |
| 1083193270 | Lisa Smith | Occupational Therapist | 243 Raspberry Rd, Leola, PA 17540-2215 | 2018-08-09 |
| Street Address |
14257 DEDEAUX RD |
| City | GULFPORT |
| State | MS |
| Zip Code | 39503-3369 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013515451 | Gulf Coast Neurospa, LLC | Psychiatry & Neurology | 8845 Lorraine Road, Gulfport, MS 39503 | 2020-10-16 |
| 1447865985 | Nicholas Wyrosdick | Physical Therapist | 12261 Us 49 #1, Gulfport, MS 39503 | 2020-09-11 |
| 1750935169 | Ladner Roy Drugs, LLC. | Pharmacy | 12261 Us 49 Suite 16, Gulfport, MS 39503 | 2019-07-25 |
| 1528559440 | Alexander Therapy Services, LLC | Clinic/Center | 15465 Oak Ln Ste 100c, Gulfport, MS 39503 | 2018-05-25 |
| 1750879003 | Heather Lynn Theisen | Nurse Practitioner | 15190 Community Rd Ste 330, Gulfport, MS 39503 | 2018-04-23 |
| 1083101216 | Gulf Coast Mental Health Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 15094 County Barn Road, Gulfport, MS 39503 | 2018-04-13 |
| 1306343173 | Dr. Raymond Monsour Scurfield, LLC | Community/Behavioral Health | 15465 Oak Lane Ste 100-g, Gulfport, MS 39503 | 2018-04-09 |
| 1952817157 | Mary Beth Welch | Behavioral Analyst | 9230 Old Lorraine Rd, Gulfport, MS 39503 | 2017-12-26 |
| 1831603257 | Beach View Family Dental, Pllc | Dentist | 9072 Lorraine Road, Gulfport, MS 39503 | 2017-11-21 |
| 1437677721 | Mary Stephens Ruffin | Social Worker | 11262 Creek Dr, Gulfport, MS 39503 | 2017-09-07 |
| Find all providers in zip 39503 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710220082 | Jane Frazier Nunnelly | Radiology | 5963 Bayview Cir S, Gulfport, FL 33707-3929 | 2013-04-04 |
| 1285760652 | Sangita T Patel Kapadia | Radiology | 5931 Bayview Cir S, Gulfport, FL 33707-3929 | 2007-02-27 |
| 1437150323 | Judith L. Corey | Radiology | 4320 15th St, Suite A, Gulfport, MS 39501-2524 | 2005-08-02 |
| 1922009810 | Milton R Raines | Radiology | 14231 Seaway Rd, Gulfport, MS 39503-4628 | 2005-08-02 |
| 1306847280 | Frank Alan Lovell | Radiology | 14231 Seaway Rd Ste 5003, Gulfport, MS 39503-4660 | 2005-08-02 |
| 1396165387 | Daniel Adams | Radiology | 4500 13th St, Gulfport, MS 39501-2515 | 2014-04-17 |
| 1518236124 | Pasadena Imaging Associates Pa | Radiology | 5931 Bayview Cir S, Gulfport, FL 33707-3929 | 2011-12-28 |
| 1922238278 | Jonathan Barry Mullins | Radiology | 14231 Seaway Rd Ste 5003, Gulfport, MS 39503-4660 | 2009-07-21 |
| 1013179266 | Raun Joseph Wetzel | Radiology | 14231 Seaway Rd, Gulfport, MS 39503-4628 | 2008-06-30 |
| 1528248960 | Russell Elbey Allman Jr. | Radiology | 14231 Seaway Rd Ste 5003, Gulfport, MS 39503-4660 | 2007-11-13 |
| Find all providers in GULFPORT | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.