Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | G59217 | CA |
N | 2080P0202X | Pediatric Cardiologist | G59217 | CA |
NPI | 1134240476 |
---|---|
Provider Name | James D. Bristow |
First Address | San Francisco, CA 94143-0374 |
Second Address | San Francisco, CA 94143-0374 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G592070 | MEDI-CAL (01) | CA |
A53476 | (02) | CA |