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General NPI Number Information
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NPI Number | 1417145921
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Entity Type | Organization
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Legal Business Name | DONNA M. BRIDGE MD PA
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 10/10/2007
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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 | 33511-5937
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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
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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 | 813-684-2506
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Fax | 813-684-5785
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Authorized Official
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Title or Position | PRESIDENR
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Name | DR. DONNA M BRIDGE
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Credential | M.D.
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Telephone | 813-684-2506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME78627
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License Number State | FL
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