Provider Demographics
NPI:1871510529
Name:BRISTOW, LONNIE ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:LONNIE
Middle Name:ROBERT
Last Name:BRISTOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3324 PTARMIGAN DR
Mailing Address - Street 2:UNIT B3
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94595-3173
Mailing Address - Country:US
Mailing Address - Phone:925-933-2733
Mailing Address - Fax:925-943-7326
Practice Address - Street 1:3324 PTARMIGAN DR
Practice Address - Street 2:UNIT B3
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94595-3173
Practice Address - Country:US
Practice Address - Phone:925-933-2733
Practice Address - Fax:925-943-7326
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG4843207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine