Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1104396217 |
---|---|
Provider Name | James W Liston |
First Address | Sandy, UT 84092-5216 |
Second Address | Murray, UT 84123-2959 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2018 |
Last Update Date | 01/12/2018 |