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General NPI Number Information
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NPI Number | 1619916012
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Entity Type | Individual
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Provider Name | ROBERT W LISLE M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 11/01/2011
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Provider Practice Location Address
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Address Line | 11 ARLEY WAY SUITE 201
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City | BLUFFTON
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State | SC
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Zip | 29910-4883
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Country | US
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Telephone | 843-706-8690
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Fax | 843-706-5066
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Provider Business Mailing Address
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Address Line | 11 ARLEY WAY SUITE 201
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City | BLUFFTON
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State | SC
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Zip | 29910-4883
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Country | US
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Telephone | 843-706-8690
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Fax | 843-706-5066
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | D14318
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 32158
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License Number State | SC
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