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NPI Code Detail

MEDICARE: DEREK CHARLES BRIDGES

MEDICARE: DEREK CHARLES BRIDGES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1134703275
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEREK CHARLES BRIDGES
Provider Business Mailing Address
First Line : 1620 E 12TH ST
Second Line :
City : TULSA
State : OK
Zip : 74120-5407
Country : US
Telephone Number : 918-924-2832
Fax Number :
Provider Business Practice Location Address
First Line : 1239 S TRENTON AVE
Second Line :
City : TULSA
State : OK
Zip : 74120-5420
Country : US
Telephone Number : 918-924-2832
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2021
Last Update Date : 05/05/2021

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Directions to “ DEREK CHARLES BRIDGES ” Practice Location

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