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General NPI Number Information
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NPI Number | 1164523825
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Entity Type | Organization
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Legal Business Name | BRISTOL PEDIATRIC ASSOCIATES, P.C.
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 320 STEELES RD
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City | BRISTOL
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State | TN
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Zip | 37620-9532
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Country | US
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Telephone | 423-968-2599
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Fax | 423-968-1974
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Provider Business Mailing Address
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Address Line | 320 STEELES RD
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City | BRISTOL
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State | TN
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Zip | 37620-9532
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Country | US
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Telephone | 423-968-2599
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Fax | 423-968-1974
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Authorized Official
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Title or Position | OWNER
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Name | DR. THOMAS DUNCAN MAKRES
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Credential | M.D.
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Telephone | 423-968-2599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD00000010083
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License Number State | TN
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