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Organization
REAGAN E. A. BRISTOL, D.O.
Active
Organization
REAGAN E. A. BRISTOL, D.O.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REAGAN E BRISTOL DO (OWNER)
(419) 627-9840
Entity
Organization
Contact information
Practice address
3006 CAMPBELL ST, SANDUSKY, OH 44870-5381
(419) 627-9840
Mailing address
3006 CAMPBELL ST, SANDUSKY, OH 44870-5381
(419) 627-9840
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
34006440
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0256628
—
OH
01
—
BR4040091
MEDICARE PROVIDER
—
Enumeration date
08/03/2015
Last updated
08/03/2015
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