Basic Information
| Provider Information | |||||||||
| NPI: | 1134240476 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRISTOW | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | M. D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | UCSF MEDICAL CENTER | ||||||||
| Address2: | 400 PARNASSUS AVENUE 2ND FLOOR | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941430374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4153532008 | ||||||||
| FaxNumber: | 9252965752 | ||||||||
| Practice Location | |||||||||
| Address1: | UCSF MEDICAL CENTER | ||||||||
| Address2: | 400 PARNASSUS AVENUE 2ND FLOOR | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941430374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4153532008 | ||||||||
| FaxNumber: | 9252965752 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | G59217 | CA | X | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0202X | G59217 | CA | X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 00G592070 | 01 | CA | MEDI-CAL | OTHER |