NPIMap

Organization Active NPI

Lisenby Podiatry

  • Podiatrist
  • Dothan, AL
National Provider Identifier
1104990415
Registry record updated May 26, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
144 Issued in AL
Legal business name
LISENBY PODIATRY
Practice address
1550 E Main St
Dothan, AL 36301-3012
Phone
(334) 671-1441
Fax
(334) 671-1688
NPI assigned
Nov 20, 2006
Last updated
May 26, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Robert Harrison Lisenby Jr.NPI 1861579500
Title
President
Phone
(334) 671-1441

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 511 GA
Podiatrist 213E00000X 144 AL Primary

Addresses

Primary practice location

1550 E Main St
Dothan, AL 36301-3012

Mailing address

1550 E Main St
Dothan, AL 36301-3012
Phone (334) 671-1441

Other identifiers 2

IdentifierTypeStateIssuer
74869OtherALBCBS
000074869MedicaidAL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243296000000",
    "number": "1104990415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1550 E MAIN ST",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363013012",
            "telephone_number": "334-671-1441",
            "fax_number": "334-671-1688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 E MAIN ST",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363013012",
            "telephone_number": "334-671-1441",
            "fax_number": "334-671-1688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LISENBY PODIATRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2009-05-26",
        "status": "A",
        "authorized_official_last_name": "LISENBY",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "HARRISON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "334-671-1441",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "GA",
            "license": "511",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "AL",
            "license": "144",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "74869",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000074869",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dothan, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.