Basic Information
| Provider Information | |||||||||
| NPI: | 1801188891 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIST | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 S 7TH AVE | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571050900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6055045400 | ||||||||
| FaxNumber: | 6055045150 | ||||||||
| Practice Location | |||||||||
| Address1: | 6215 SOUTH CLIFF AVENUE | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571088589 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053223300 | ||||||||
| FaxNumber: | 6053223301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2011 | ||||||||
| LastUpdateDate: | 04/18/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 9187 | SD | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.