Basic Information
| Provider Information | |||||||||
| NPI: | 1760782817 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEAN | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | MICHELLE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5654 LEESWAY BLVD | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325047726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403252458 | ||||||||
| FaxNumber: | 8504162467 | ||||||||
| Practice Location | |||||||||
| Address1: | 223 W COLE BLVD | ||||||||
| Address2: | |||||||||
| City: | CALEXICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922319722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603572020 | ||||||||
| FaxNumber: | 7603571056 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2010 | ||||||||
| LastUpdateDate: | 07/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | ME108952 | FL | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | TRN14227 | FL | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VX0201X | A125372 | CA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology |
No ID Information.