Individual
DAVID P. LISBON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 E MOUNTAIN BLVD, WILKES BARRE, PA 18711-0027
(570) 808-7762
(570) 808-7762
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-4903
(570) 271-6144
(570) 271-6578
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
04-29512
KS
207P00000X
Emergency Medicine Physician
Primary
MD473063
PA
207R00000X
Internal Medicine Physician
04-29512
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10001612201
CHP PROVIDER NUMBER
—
05
—
200267750A
—
KS
05
—
202299129
—
MO
01
—
21474034
BCBSKC PROVIDER NUMBER
—
01
—
306302
FIRSTGUARD
—
01
—
481202402
PSKU TAX ID
—
01
—
5640019
AETNA
—
01
—
P00193174
RR MEDICARE
—
Enumeration date
09/01/2006
Last updated
03/08/2021
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