Healthcare Provider Details

I. General information

NPI: 1710296371
Provider Name (Legal Business Name): BENJAMIN NORMAN BRISTOW MD, MPH, DTM&H
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2010
Last Update Date: 12/15/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 GEARY BLVD # M160
SAN FRANCISCO CA
94115-3358
US

IV. Provider business mailing address

10 LEYTON CT
MILL VALLEY CA
94941-1504
US

V. Phone/Fax

Practice location:
  • Phone: 415-833-3034
  • Fax: 415-833-4983
Mailing address:
  • Phone: 415-342-1656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberM1997
License Number StateGU
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA105377
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberM1997
License Number StateGU
# 4
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberA105377
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberM1997
License Number StateGU
# 6
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA105377
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: