Individual
DR. BRAD ALAN LISTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1908 N 14TH ST STE 204, PONCA CITY, OK 74601-2039
(580) 763-5900
(580) 763-5901
Mailing address
1908 N 14TH ST STE 204, PONCA CITY, OK 74601-2039
(580) 763-5900
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
4659
OK
Other
Enumeration date
07/09/2008
Last updated
09/16/2020
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