Basic Information
| Provider Information | |||||||||
| NPI: | 1801123807 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LISA KNIGHT FLAREY, D.O., INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 945 BETHESDA DR | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437010801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142971158 | ||||||||
| FaxNumber: | 6142993406 | ||||||||
| Practice Location | |||||||||
| Address1: | 945 BETHESDA DR | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437010801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142971158 | ||||||||
| FaxNumber: | 6142993406 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2009 | ||||||||
| LastUpdateDate: | 11/11/2009 | ||||||||
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| AuthorizedOfficialLastName: | FLAREY | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6142971158 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 34007956 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.