Provider Demographics
NPI:1316995855
Name:LISTON, DENNIS MICHAEL (MD PA)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:MICHAEL
Last Name:LISTON
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4800 NE 20TH TER
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4510
Mailing Address - Country:US
Mailing Address - Phone:954-492-4525
Mailing Address - Fax:954-492-4535
Practice Address - Street 1:4800 NE 20TH TER
Practice Address - Street 2:SUITE 202
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4510
Practice Address - Country:US
Practice Address - Phone:954-492-4525
Practice Address - Fax:954-492-4535
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00594462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370574901Medicaid
FL12862ZMedicare PIN
FL370574901Medicaid