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General NPI Number Information
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NPI Number | 1952881484
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Entity Type | Organization
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Legal Business Name | BRIDGES HEALTHCARE
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Dates
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Enumeration Date | 08/15/2018
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Last Update Date | 08/15/2018
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Provider Practice Location Address
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Address Line | 4951 LONG PRAIRIE RD STE 100
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City | FLOWER MOUND
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State | TX
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Zip | 75028-2709
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Country | US
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Telephone | 972-420-8777
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Fax | 949-437-2939
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Provider Business Mailing Address
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Address Line | 4951 LONG PRAIRIE RD STE 100
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City | FLOWER MOUND
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State | TX
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Zip | 75028-2709
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Country | US
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Telephone | 972-420-8777
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Fax | 949-437-2939
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Authorized Official
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Title or Position | PHYSICIAN/ OWNER
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Name | DR. TIM SHEPHERD
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Credential | MD
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Telephone | 972-420-8777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | F4518
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License Number State | TX
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