Provider Demographics
NPI:1043473507
Name:KISTLER, BRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:KISTLER
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 1:2342 PROFESSIONAL PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-1690
Mailing Address - Country:US
Mailing Address - Phone:805-349-9545
Mailing Address - Fax:805-349-8025
Practice Address - Street 1:2342 PROFESSIONAL PKWY STE 200
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-1690
Practice Address - Country:US
Practice Address - Phone:805-349-9545
Practice Address - Fax:805-349-8025
Is Sole Proprietor?:No
Enumeration Date:2008-07-04
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC170907207XX0801X
FLME115203207X00000X
NY274343207X00000X, 207XX0801X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03894575Medicaid
FL008716800Medicaid
FLHI136ZMedicare PIN