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General NPI Number Information
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NPI Number | 1043442676
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Entity Type | Organization
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Legal Business Name | BRIDGEWATER WOMEN CENTER, LLC
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Dates
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Enumeration Date | 08/15/2009
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Last Update Date | 08/15/2009
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Provider Practice Location Address
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Address Line | 16782 NW 67TH AVE
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City | HIALEAH
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State | FL
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Zip | 33015-4202
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Country | US
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Telephone | 954-671-0111
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Fax | 954-671-0070
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Provider Business Mailing Address
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Address Line | 3071 NW 70TH TER
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City | MIAMI
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State | FL
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Zip | 33147-6740
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Country | US
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Telephone | 305-458-1913
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Fax | 954-671-0070
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD LEON BRIDGEWATER
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Credential | MD
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Telephone | 954-671-0111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME63506
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License Number State | FL
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