Healthcare Provider Details

I. General information

NPI: 1861563942
Provider Name (Legal Business Name): KAREN E LISTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 DOUGHERTY FERRY RD
SAINT LOUIS MO
63122-3313
US

IV. Provider business mailing address

604 CORLEY CT
CHESTERFIELD MO
63017-7070
US

V. Phone/Fax

Practice location:
  • Phone: 314-966-9590
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberMDR5P27
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: