Healthcare Provider Details

I. General information

NPI: 1851667562
Provider Name (Legal Business Name): ERIN WILKERSON BRIDGEWATER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 05/19/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 S PRESTON RD STE 100
CELINA TX
75009
US

IV. Provider business mailing address

PO BOX 733784
DALLAS TX
75373-3784
US

V. Phone/Fax

Practice location:
  • Phone: 945-204-7960
  • Fax: 945-204-7961
Mailing address:
  • Phone: 682-885-6483
  • Fax: 682-303-7132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberQ4045
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: