Provider Demographics
NPI:1821209081
Name:LISTON, DAVID EVAN (MD, MPH)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:EVAN
Last Name:LISTON
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 SAND POINT WAY NE
Mailing Address - Street 2:W-9824
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3901
Mailing Address - Country:US
Mailing Address - Phone:206-987-3996
Mailing Address - Fax:206-987-3935
Practice Address - Street 1:4800 SAND POINT WAY NE
Practice Address - Street 2:W-9824
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3901
Practice Address - Country:US
Practice Address - Phone:206-987-3996
Practice Address - Fax:206-987-3935
Is Sole Proprietor?:No
Enumeration Date:2007-05-26
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60035791207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
BP4-0026369OtherINSTITUTIONAL PERMIT