Healthcare Provider Details

I. General information

NPI: 1821209081
Provider Name (Legal Business Name): DAVID EVAN LISTON MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2007
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE W-9824
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

4800 SAND POINT WAY NE W-9824
SEATTLE WA
98105-3901
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-3996
  • Fax: 206-987-3935
Mailing address:
  • Phone: 206-987-3996
  • Fax: 206-987-3935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberMD60035791
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: