MEDICARE: DR. DANIEL LISTER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	33796	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073599817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL LISTER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 91407
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57109-1407
Country	:	US
Telephone Number	:	605-312-7606
Fax Number	:	605-312-7611

Provider Business Practice Location Address
First Line	:	300 S BRUCE ST
Second Line	:
City	:	MARSHALL
State	:	MN
Zip	:	56258-1934
Country	:	US
Telephone Number	:	507-532-9661
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	04/29/2021

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