Provider Demographics
NPI:1780760595
Name:BRISTOL, PAUL ELLIS (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ELLIS
Last Name:BRISTOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 W PARMER LN STE A250
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-4115
Mailing Address - Country:US
Mailing Address - Phone:512-799-1345
Mailing Address - Fax:844-445-6850
Practice Address - Street 1:4201 W PARMER LN STE A250
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78727-4115
Practice Address - Country:US
Practice Address - Phone:512-799-1345
Practice Address - Fax:844-445-6850
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9265207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB21509Medicare UPIN
TX00047MMedicare PIN