Individual provider · Type 1 NPI
Brad Alan Liston, DO
Adult Medicine Physician · Ponca City, OK
NPI number
1487817375
Active
Practice location
1908 N 14th St Ste 204
Ponca City, OK 74601-2039
Fax (580) 763-5901
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Adult Medicine Physician Primary | 207QA0505X | 4659 (OK) |
Adult Medicine Physician: The NUCC recommends this code not be used. Choose a more appropriate code.
About NPI 1487817375
Brad Alan Liston, DO's National Provider Identifier is 1487817375, issued on Jul 9, 2008. The primary taxonomy on file is Adult Medicine Physician (207QA0505X), and the practice location is in Ponca City, OK. The record was last updated on Sep 16, 2020.