Individual
DOUGLAS S LISTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
2720 HOMESTEAD ROAD, SUITE 50, PARK CITY, UT 84098-4885
(435) 604-0449
(435) 649-9202
Mailing address
PO BOX 34120, RENO, NV 89533-4120
(775) 747-5050
(775) 329-8596
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
E41920
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000065013
—
UT
01
—
6619665-0501
UTAH LICENSE
UT
Enumeration date
04/10/2007
Last updated
10/15/2012
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