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General NPI Number Information
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NPI Number | 1225002132
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Entity Type | Individual
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Provider Name | CLIFFORD STUART BRISTOL M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/15/2006
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Last Update Date | 03/02/2012
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Provider Practice Location Address
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Address Line | 17808 NE CHARLIE JOHNS ST
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City | BLOUNTSTOWN
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State | FL
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Zip | 32424-1052
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Country | US
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Telephone | 850-674-4524
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Fax | 850-674-2300
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Provider Business Mailing Address
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Address Line | 17808 NE CHARLIE JOHNS ST
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City | BLOUNTSTOWN
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State | FL
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Zip | 32424-1052
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Country | US
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Telephone | 850-674-4524
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Fax | 850-674-2300
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME30535
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License Number State | FL
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