Organization
BRISTOL PARK MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK D SCHAFER MD (MEDICAL DIRECTOR)
(714) 665-1661
Entity
Organization
Contact information
Practice address
2742 DOW AVE, TUSTIN, CA 92780-7242
(714) 665-1661
(714) 665-1669
Mailing address
2742 DOW AVE, TUSTIN, CA 92780-7242
(714) 665-1600
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
302F00000X
Exclusive Provider Organization
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0069190
—
CA
05
—
GR0069194
—
CA
05
—
GR0069196
—
CA
05
—
GR0069197
—
CA
05
—
GR0069198
—
CA
05
—
GR0069199
—
CA
05
—
GR006919A
—
CA
05
—
GR006919B
—
CA
05
—
GR006919G
—
CA
05
—
GR006919H
—
CA
05
—
GR006919J
—
CA
Enumeration date
11/01/2006
Last updated
10/15/2008
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