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General NPI Number Information
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NPI Number | 1043513435
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Entity Type | Organization
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Legal Business Name | NORTHWEST PHYSICIANS MEDICAL GROUP, PLLC
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Dates
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Enumeration Date | 12/07/2010
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 5920 100TH ST SW STE 31
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City | LAKEWOOD
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State | WA
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Zip | 98499-2751
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Country | US
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Telephone | 253-584-3023
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Fax | 253-582-1222
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Provider Business Mailing Address
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Address Line | 5920 100TH ST SW STE 30
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City | LAKEWOOD
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State | WA
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Zip | 98499-2751
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Country | US
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Telephone | 253-830-2030
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Fax | 253-830-2055
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THEODORE BRIDGE
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Credential | M.D.
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Telephone | 206-715-4652
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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Taxonomy #5
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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