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NPI Code Detail

MEDICARE: RICQUE L. BRISTER MD

MEDICARE: RICQUE L. BRISTER MD
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
1208D00000XGeneral Practice PhysicianME145234FL
22084P0800XPsychiatry PhysicianG4857TX
32084P0800XPsychiatry PhysicianME145234FL
42084P0800XPsychiatry PhysicianA-42685CA

General Provider Information

NPI Number : 1932320389
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICQUE L. BRISTER MD
Provider Business Mailing Address
First Line : 4441 E KINGS CANYON RD
Second Line :
City : FRESNO
State : CA
Zip : 93702-3604
Country : US
Telephone Number : 559-600-4645
Fax Number :
Provider Business Practice Location Address
First Line : 7877 WILLOW CHASE BLVD
Second Line :
City : HOUSTON
State : TX
Zip : 77070-5934
Country : US
Telephone Number : 832-869-4818
Fax Number : 832-241-2902
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2007
Last Update Date : 11/05/2024

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