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General NPI Number Information
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NPI Number | 1245295609
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Entity Type | Individual
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Provider Name | PETER MARK BRIDGE MD
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Gender | Male
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 06/27/2016
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Provider Practice Location Address
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Address Line | 608 MEDICAL CARE DR
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City | BRANDON
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State | FL
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Zip | 33511
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Country | US
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Telephone | 813-684-2506
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Fax | 813-684-5785
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Provider Business Mailing Address
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Address Line | 608 MEDICAL CARE DR BLDG 7-601
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City | BRANDON
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State | FL
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Zip | 33511-5937
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Country | US
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Telephone | 404-842-5400
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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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | ME79084
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License Number State | FL
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