Healthcare Provider Details

I. General information

NPI: 1811954175
Provider Name (Legal Business Name): JULIA A BRIDGE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

988102 NEBRASKA MEDICAL CTR
OMAHA NE
68198-8102
US

IV. Provider business mailing address

988102 NEBRASKA MEDICAL CTR
OMAHA NE
68198-8102
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-4186
  • Fax: 402-559-6018
Mailing address:
  • Phone: 402-559-4186
  • Fax: 402-559-6018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SC0300X
TaxonomyClinical Cytogenetics Physician
License Number18409
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number18409
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number13980734-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: