Provider Demographics
NPI:1447541750
Name:LISLE, STUART JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:JOSEPH
Last Name:LISLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7530 NW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-4921
Mailing Address - Country:US
Mailing Address - Phone:405-787-8562
Mailing Address - Fax:405-787-8533
Practice Address - Street 1:7530 NW 23RD ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-4921
Practice Address - Country:US
Practice Address - Phone:405-787-8562
Practice Address - Fax:405-787-8533
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK31441207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK31441OtherSTATE MEDICAL LICENSE