Provider Demographics
NPI:1306810585
Name:LIST, PATRICK (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:LIST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7339
Mailing Address - Street 2:UHS
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78713-7339
Mailing Address - Country:US
Mailing Address - Phone:512-485-8406
Mailing Address - Fax:
Practice Address - Street 1:100 W DEAN KEETON
Practice Address - Street 2:UHS
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712
Practice Address - Country:US
Practice Address - Phone:512-485-8406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238459207R00000X
OR27489207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10001036OtherSENTARA/OPTIMA
VA541595397OtherVIRGINIA HEALTH NETWORK
VA186203OtherANTHEM
VA7231606OtherAETNA
VA541595397OtherMID ATLANTIC SOLUTIONS
VA010207088Medicaid
VA541595397OtherMID ATLANTIC SOLUTIONS
VA008846B28Medicare ID - Type Unspecified
VA010207088Medicaid
OR1306810585Medicare PIN