Individual
DR. DEREK ANTHONY MCLISTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M
Contact information
Practice address
5225 23RD AVE S, FARGO, ND 58104-7927
(701) 417-2575
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
Taxonomy
Speciality
Code
Description
License number
State
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
86
ND
213E00000X
Podiatrist
Primary
1068
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
ND
Other
Enumeration date
05/04/2017
Last updated
04/04/2022
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