Individual
DR. LISA R RENDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3381 W BAVARIA ST, EAGLE, ID 83616-5341
(208) 287-1110
(208) 639-4801
Mailing address
3381 W BAVARIA ST, EAGLE, ID 83616-5341
(208) 287-1110
(208) 639-4801
Taxonomy
Speciality
Code
Description
License number
State
207XS0106X
Orthopaedic Hand Surgery Physician
Primary
M9105
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807057200
—
ID
Enumeration date
11/10/2005
Last updated
05/22/2012
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