MEDICARE: MR. DUANE E BRIDGES M.D.

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
1	207RC0001X	Clinical Cardiac Electrophysiology Physician	G63954	CA
2	207RC0000X	Cardiovascular Disease Physician	G63954	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154352011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DUANE E BRIDGES M.D.

Provider Business Mailing Address
First Line	:	11633 HAWTHORNE BLVD
Second Line	:	#400
City	:	HAWTHORNE
State	:	CA
Zip	:	90250-2321
Country	:	US
Telephone Number	:	310-973-0600
Fax Number	:	310-419-0834

Provider Business Practice Location Address
First Line	:	11633 HAWTHORNE BLVD
Second Line	:	#400
City	:	HAWTHORNE
State	:	CA
Zip	:	90250-2321
Country	:	US
Telephone Number	:	310-973-0600
Fax Number	:	310-419-0834

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	03/24/2010

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Directions to “ MR. DUANE E BRIDGES M.D.” Practice Location

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