Individual
BRIAN W WISTOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
A33568
CA
2085R0202X
Diagnostic Radiology Physician
Primary
A33568
CA
2085U0001X
Diagnostic Ultrasound Physician
A33568
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A335680
—
CA
Enumeration date
05/10/2006
Last updated
03/01/2011
Update your record
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