Organization
BRISTOL PARK MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK D SCHAFER MD (MEDICAL DIRECTOR)
(714) 665-1661
Entity
Organization
Contact information
Practice address
722 BAKER ST, COSTA MESA, CA 92626-4320
(714) 557-6300
(714) 966-9567
Mailing address
2742 DOW AVE, TUSTIN, CA 92780-7242
(714) 665-1600
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0069199
—
CA
Enumeration date
05/25/2006
Last updated
10/15/2008
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