MEDICARE: LISTON STEPHEN JONES JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	00006675	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0410322	OTHER	AL	UNITED HEALTHCARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	051018020	OTHER	AL	BCBS

General Provider Information

NPI Number	:	1639177553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISTON STEPHEN JONES JR. MD

Provider Business Mailing Address
First Line	:	PO BOX 160928
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36616-1928
Country	:	US
Telephone Number	:	251-414-5900
Fax Number	:	251-342-3842

Provider Business Practice Location Address
First Line	:	101 MEMORIAL HOSPITAL DR
Second Line	:	SUITE 200
City	:	MOBILE
State	:	AL
Zip	:	36608-1753
Country	:	US
Telephone Number	:	251-414-5900
Fax Number	:	251-281-1162

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	09/19/2011

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