Lisa R Rendon, M.D.

Primary specialty

Orthopaedic Hand Surgery PhysicianTaxonomy code 207XS0106X

License

M9105 Issued in ID

Practice address

3381 W Bavaria St
Eagle, ID 83616-5341

Phone

(208) 287-1110

Fax

(208) 639-4801

NPI assigned

Nov 10, 2005

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1131580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337644800000",
    "number": "1528049178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3381 W BAVARIA ST",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836165341",
            "telephone_number": "208-287-1110",
            "fax_number": "208-639-4801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3381 W BAVARIA ST",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836165341",
            "telephone_number": "208-287-1110",
            "fax_number": "208-639-4801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENDON",
        "first_name": "LISA",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-11-10",
        "last_updated": "2012-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XS0106X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Hand Surgery",
            "state": "ID",
            "license": "M9105",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807057200",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Orthopaedic Hand Surgery Physician in Eagle, ID
• Providers in Eagle, ID by specialty
• Orthopaedic Hand Surgery Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2012; 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.