Healthcare Provider Details

I. General information

NPI: 1043473507
Provider Name (Legal Business Name): BRIAN KISTLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2008
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 S STRATFORD AVE STE A
SANTA MARIA CA
93454-5901
US

IV. Provider business mailing address

206 S STRATFORD AVE STE A
SANTA MARIA CA
93454-5901
US

V. Phone/Fax

Practice location:
  • Phone: 805-928-5767
  • Fax: 805-349-0222
Mailing address:
  • Phone: 805-739-3805
  • Fax: 805-739-3806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberC170907
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME115203
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number274343
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number274343
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: