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General NPI Number Information
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NPI Number | 1245479948
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Entity Type | Organization
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Legal Business Name | J.T. BRISTOL, M.D., LLC
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Dates
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Enumeration Date | 02/19/2009
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Last Update Date | 02/19/2009
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Provider Practice Location Address
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Address Line | 680 S MAIN ST SUITE 102
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City | CHESHIRE
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State | CT
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Zip | 06410-3181
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Country | US
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Telephone | 860-818-6668
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Fax |
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Provider Business Mailing Address
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Address Line | 680 S MAIN ST SUITE 102
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City | CHESHIRE
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State | CT
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Zip | 06410-3181
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Country | US
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Telephone | 860-818-6668
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Fax |
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Authorized Official
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Title or Position | OWNER/SOLE PROPRIETOR
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Name | JYOJI T BRISTOL
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Credential | MD
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Telephone | 860-818-6668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 040914
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License Number State | CT
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