Individual
DR. LISA M MADDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4410 MEDICAL DR STE 550, SAN ANTONIO, TX 78229-3755
(210) 575-3817
Mailing address
4410 MEDICAL DR, SUITE 410, SAN ANTONIO, TX 78229-6306
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Q9189
TX
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
Q9189
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
361904101
—
TX
05
—
361904102
—
TX
01
—
8GB634
BCBS - TX
TX
01
—
MEDICARE
523595YLLW
TX
Enumeration date
03/16/2007
Last updated
01/03/2018
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