Healthcare Provider Details

I. General information

NPI: 1629023437
Provider Name (Legal Business Name): WALTER STEVEN BRIDGES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E CHEVES ST
FLORENCE SC
29506-2716
US

IV. Provider business mailing address

901 E CHEVES ST
FLORENCE SC
29506-2716
US

V. Phone/Fax

Practice location:
  • Phone: 843-667-6229
  • Fax: 843-667-1758
Mailing address:
  • Phone: 843-667-6229
  • Fax: 843-667-1758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number16800
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: