Organization
BRISTOL PARK MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK D SCHAFER MD (MEDICAL DIRECTOR)
(714) 665-1600
Entity
Organization
Contact information
Practice address
15 MAREBLU, SUITE 100, ALISO VIEJO, CA 92656-3015
(949) 448-0656
(949) 425-2465
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
—
GR006919J
—
CA
Enumeration date
05/26/2006
Last updated
05/07/2009
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