Healthcare Provider Details

I. General information

NPI: 1356355036
Provider Name (Legal Business Name): RONZEE MCINTYRE BRIDGES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
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:
Title or Position:
Credential:
Phone: