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General NPI Number Information
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NPI Number | 1518313535
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Entity Type | Organization
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Legal Business Name | DAN LISTER, MD PA
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Dates
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Enumeration Date | 05/09/2016
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Last Update Date | 05/09/2016
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Provider Practice Location Address
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Address Line | 309 SOUTHRIDGE BLVD STE. A
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City | HEBER SPRINGS
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State | AR
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Zip | 72543-8875
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Country | US
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Telephone | 501-250-2020
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Fax | 501-250-0200
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Provider Business Mailing Address
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Address Line | 309 SOUTHRIDGE BLVD STE. A
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City | HEBER SPRINGS
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State | AR
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Zip | 72543-8875
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Country | US
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Telephone | 501-250-2020
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Fax | 501-250-0200
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DANNY GENE LISTER
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Credential | M.D.
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Telephone | 501-250-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | E1741
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License Number State | AR
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