Provider Demographics
NPI:1164659827
Name:J.T. BRISTOL, M.D., LLC
Entity Type:Organization
Organization Name:J.T. BRISTOL, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLO PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JYOJI
Authorized Official - Middle Name:T
Authorized Official - Last Name:BRISTOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-483-2015
Mailing Address - Street 1:84 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3061
Mailing Address - Country:US
Mailing Address - Phone:203-483-2015
Mailing Address - Fax:203-483-2016
Practice Address - Street 1:84 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3061
Practice Address - Country:US
Practice Address - Phone:203-483-2015
Practice Address - Fax:203-483-2016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty