Individual
DR. STUART JOSEPH LISLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7530 NW 23RD ST, BETHANY, OK 73008-4921
(405) 787-8562
(405) 787-8533
Mailing address
7530 NW 23RD ST, BETHANY, OK 73008-4921
(405) 787-8562
(405) 787-8533
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
31441
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31441
STATE MEDICAL LICENSE
OK
Enumeration date
04/21/2011
Last updated
06/16/2018
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