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General NPI Number Information
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NPI Number | 1194724856
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Entity Type | Individual
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Provider Name | CLIFTON LEE BRIDGES JR. MD
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Gender | Male
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Dates
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Enumeration Date | 07/15/2005
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Last Update Date | 12/29/2016
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Provider Practice Location Address
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Address Line | 5801 BREMO RD
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City | RICHMOND
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State | VA
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Zip | 23226-1907
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Country | US
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Telephone | 804-285-2011
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5468
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City | MARTINSVILLE
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State | VA
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Zip | 24115-5468
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 0101102390
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207ZC0500X
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Taxonomy Name | Cytopathology Physician
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License Number | 0101102390
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License Number State | VA
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