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General NPI Number Information
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NPI Number | 1306810585
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Entity Type | Individual
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Provider Name | PATRICK LIST MD
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Gender | Male
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Dates
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Enumeration Date | 02/15/2006
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Last Update Date | 08/11/2010
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Provider Practice Location Address
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Address Line | 100 W DEAN KEETON UHS
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City | AUSTIN
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State | TX
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Zip | 78712
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Country | US
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Telephone | 512-485-8406
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7339 UHS
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City | AUSTIN
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State | TX
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Zip | 78713-7339
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Country | US
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Telephone | 512-485-8406
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101238459
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207RS0010X
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Taxonomy Name | Sports Medicine (Internal Medicine) Physician
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License Number | 27489
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License Number State | OR
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