Healthcare Provider Details

I. General information

NPI: 1306810585
Provider Name (Legal Business Name): PATRICK LIST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W DEAN KEETON UHS
AUSTIN TX
78712
US

IV. Provider business mailing address

PO BOX 7339 UHS
AUSTIN TX
78713-7339
US

V. Phone/Fax

Practice location:
  • Phone: 512-485-8406
  • Fax:
Mailing address:
  • Phone: 512-485-8406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101238459
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number27489
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: