Provider Demographics
NPI:1710296371
Name:BRISTOW, BENJAMIN NORMAN (MD, MPH, DTM&H)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:NORMAN
Last Name:BRISTOW
Suffix:
Gender:M
Credentials:MD, MPH, DTM&H
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 LEYTON CT
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-1504
Mailing Address - Country:US
Mailing Address - Phone:415-342-1656
Mailing Address - Fax:
Practice Address - Street 1:2425 GEARY BLVD # M160
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3358
Practice Address - Country:US
Practice Address - Phone:415-833-3034
Practice Address - Fax:415-833-4983
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM1997207R00000X, 2083P0901X, 208M00000X
CAA105377207R00000X, 2083P0901X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine