Healthcare Provider Details

I. General information

NPI: 1407974611
Provider Name (Legal Business Name): WILLIAM H BRIDGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MARGARET LN SUITE C
GRASS VALLEY CA
95945-4207
US

IV. Provider business mailing address

101 MARGARET LN SUITE C
GRASS VALLEY CA
95945-4207
US

V. Phone/Fax

Practice location:
  • Phone: 530-272-2244
  • Fax: 530-272-4120
Mailing address:
  • Phone: 530-272-2244
  • Fax: 530-272-4120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA24361
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: