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General NPI Number Information
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NPI Number | 1295958312
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Entity Type | Individual
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Provider Name | DOUGLAS S LISTER DPM
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Gender | Male
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 10/15/2012
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Provider Practice Location Address
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Address Line | 2720 HOMESTEAD ROAD SUITE 50
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City | PARK CITY
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State | UT
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Zip | 84098-4885
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Country | US
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Telephone | 435-604-0449
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Fax | 435-649-9202
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Provider Business Mailing Address
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Address Line | PO BOX 34120
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City | RENO
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State | NV
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Zip | 89533-4120
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Country | US
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Telephone | 775-747-5050
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Fax | 775-329-8596
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | E41920
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License Number State | CA
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