Provider Demographics
NPI:1386673010
Name:BRIONES, TRISTAN CALDERON II (MD)
Entity Type:Individual
Prefix:DR
First Name:TRISTAN
Middle Name:CALDERON
Last Name:BRIONES
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TRISTAN
Other - Middle Name:C
Other - Last Name:BRIONES
Other - Suffix:II
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2780 FREDERICA STREET
Mailing Address - Street 2:WESLEYAN PARK PLAZA
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301
Mailing Address - Country:US
Mailing Address - Phone:270-926-4100
Mailing Address - Fax:270-684-4678
Practice Address - Street 1:2780 FREDERICA STREET
Practice Address - Street 2:WESLEYAN PARK PLAZA
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301
Practice Address - Country:US
Practice Address - Phone:270-926-4100
Practice Address - Fax:270-684-4678
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40170208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation