Individual
DAVID LISLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
192 TILLEY DR, ORTHOPAEDIC SPECIALTY CENTER, SOUTH BURLINGTON, VT 05403-4440
(802) 847-2663
Mailing address
192 TILLEY DR, ORTHOPAEDIC SPECIALTY CENTER, SOUTH BURLINGTON, VT 05403-4440
(802) 847-2663
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
042-0011500
VT
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
042-0011500
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8475287
—
WA
Enumeration date
02/15/2007
Last updated
09/01/2016
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