Healthcare Provider Details

I. General information

NPI: 1295749257
Provider Name (Legal Business Name): BRIDGES TO INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 YOUREE DR SUITE 300
SHREVEPORT LA
71105-3329
US

IV. Provider business mailing address

4300 YOUREE DR SUITE 300
SHREVEPORT LA
71105-3329
US

V. Phone/Fax

Practice location:
  • Phone: 318-219-8555
  • Fax: 318-219-8557
Mailing address:
  • Phone: 318-219-8555
  • Fax: 318-219-8557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number017536
License Number StateLA

VIII. Authorized Official

Name: DR. RONZEE MCINTYRE BRIDGES
Title or Position: PRESIDENT
Credential: M.D.
Phone: 318-219-8555