Provider Demographics
NPI:1255322632
Name:LISTER, DANA T (DO)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:T
Last Name:LISTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3920
Mailing Address - Country:US
Mailing Address - Phone:954-493-6496
Mailing Address - Fax:954-493-6726
Practice Address - Street 1:789 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1218
Practice Address - Country:US
Practice Address - Phone:954-315-5784
Practice Address - Fax:954-522-0755
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14229208000000X, 208000000X
KY02543208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018700800Medicaid
KYU82682Medicare UPIN
KY64025430Medicaid