Healthcare Provider Details

I. General information

NPI: 1417219288
Provider Name (Legal Business Name): TRISTAN MICHAEL SPIERLING D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 SCOTT CIR
JBPHH HI
96853-5399
US

IV. Provider business mailing address

101 BODIN CIR
FAIRFIELD CA
94535-1809
US

V. Phone/Fax

Practice location:
  • Phone: 808-448-6110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101020055
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: