Provider Demographics
NPI:1467766790
Name:RONALD G. BRISTOW, M.D. AND ASSOC.
Entity Type:Organization
Organization Name:RONALD G. BRISTOW, M.D. AND ASSOC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:GRIFFITH
Authorized Official - Last Name:BRISTOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-328-8200
Mailing Address - Street 1:1110 N BUCKNER BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-3487
Mailing Address - Country:US
Mailing Address - Phone:214-328-8200
Mailing Address - Fax:214-328-1332
Practice Address - Street 1:1110 N BUCKNER BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-3487
Practice Address - Country:US
Practice Address - Phone:214-328-8200
Practice Address - Fax:214-328-1332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3217261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00BE64Medicare PIN
TXC13770Medicare UPIN