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Individual
DR. SUSAN BRISTER
Active
Individual
DR. SUSAN BRISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
L9111
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1703035-01
—
TX
05
—
170303504
—
TX
01
—
314182YLPS
WELLMED PTAN
TX
01
—
P00164042
RR/MEDICARE
TX
Enumeration date
03/21/2006
Last updated
12/02/2016
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