Healthcare Provider Details

I. General information

NPI: 1225270804
Provider Name (Legal Business Name): DAVID ANDREW BRISTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2009
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 S ORANGE AVE FL 2
ORLANDO FL
32806-1215
US

IV. Provider business mailing address

1222 S ORANGE AVE FL 2
ORLANDO FL
32806-1215
US

V. Phone/Fax

Practice location:
  • Phone: 407-649-6907
  • Fax: 321-841-5245
Mailing address:
  • Phone: 407-649-6907
  • Fax: 321-841-5245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35-128178
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number35-128178
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number60 268245
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberME136219
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: