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NPI Code Detail

MEDICARE: DANIEL JOSEPH BRISTOW M.D.

MEDICARE: DANIEL JOSEPH BRISTOW M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry PhysicianMD60626573WA
22084P0800XPsychiatry PhysicianC161420CA
32084P0800XPsychiatry PhysicianMD157362OR

General Provider Information

NPI Number : 1205152832
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIEL JOSEPH BRISTOW M.D.
Provider Business Mailing Address
First Line : 10260 SW GREENBURG RD STE 400
Second Line :
City : PORTLAND
State : OR
Zip : 97223-5514
Country : US
Telephone Number : 503-966-5417
Fax Number : 503-662-1154
Provider Business Practice Location Address
First Line : 10260 SW GREENBURG RD STE 400
Second Line :
City : PORTLAND
State : OR
Zip : 97223-5514
Country : US
Telephone Number : 503-966-5417
Fax Number : 503-662-1154
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2010
Last Update Date : 08/07/2025

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