Individual
DR. LISA DIANE FAIRWEATHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
5601 BRIDGE ST., #324, FT. WORTH, TX 76112
(817) 457-4646
(817) 492-7135
Mailing address
5601 BRIDGE ST., #324, FT. WORTH, TX 76112
(817) 457-4646
(817) 492-7135
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
L6256
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
175470702
—
TX
Enumeration date
05/17/2006
Last updated
10/14/2010
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