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NPI Code Detail

MEDICARE: BRISTOL PARK MEDICAL GROUP, INC.

MEDICARE: BRISTOL PARK MEDICAL GROUP, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician
2208000000XPediatrics Physician
3332B00000XDurable Medical Equipment & Medical Supplies
4207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1275580995
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRISTOL PARK MEDICAL GROUP, INC.
Provider Business Mailing Address
First Line : 2742 DOW AVE
Second Line :
City : TUSTIN
State : CA
Zip : 92780-7242
Country : US
Telephone Number : 714-665-1600
Fax Number :
Provider Business Practice Location Address
First Line : 1212 W 17TH ST
Second Line :
City : SANTA ANA
State : CA
Zip : 92706-3418
Country : US
Telephone Number : 714-954-0432
Fax Number : 714-796-6265
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : MR. MARK D SCHAFER
Credential : MD
Telephone Number : 714-665-1661
Provider Enumeration Date : 05/28/2006
Last Update Date : 10/15/2008

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