MEDICARE: JERRY ALAN BRIDGHAM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080A0000X	Pediatric Adolescent Medicine Physician	ME49397	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740361336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRY ALAN BRIDGHAM MD

Provider Business Mailing Address
First Line	:	PO BOX 44004
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32231-4004
Country	:	US
Telephone Number	:	904-202-1032
Fax Number	:	904-268-9708

Provider Business Practice Location Address
First Line	:	14810 OLD SAINT AUGUSTINE RD STE 106
Second Line	:	CREDENTIALING DEPARTMENT
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-2558
Country	:	US
Telephone Number	:	904-268-7701
Fax Number	:	904-268-9708

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	11/19/2015

Similar Medicare Providers

1326022948 — DR. RASHEED A. AWAN D.O.
Practice Location Address:

14810 OLD SAINT AUGUSTINE RD STE 101
JACKSONVILLE, FL
32258-2558

Practice Phone: 904-435-0600
Practice Fax: 904-264-9750

1134167687 — JEAN HELEN MCCLINTOCK MD
Practice Location Address:

14810 OLD SAINT AUGUSTINE RD STE 103
JACKSONVILLE, FL
32258-2558

Practice Phone: 904-512-1899
Practice Fax: 904-503-1052

1053336933 — DR. BERNARD H. GUIOT M.D.
Practice Location Address:

14810 OLD SAINT AUGUSTINE RD STE 207
JACKSONVILLE, FL
32258-2558

Practice Phone: 904-217-7450
Practice Fax: 904-217-7483

1457455743 — MS. MARY JOYCE OHALLORAN PA
Practice Location Address:

14810 OLD SAINT AUGUSTINE RD STE 207
JACKSONVILLE, FL
32258-2558

Practice Phone: 904-738-8321
Practice Fax: 904-217-7483

1629159223 — VIRGINIA GIBSON BLACK M.D.
Practice Location Address:

14810 OLD SAINT AUGUSTINE RD STE 106 , CREDENTIALING DEPARTMENT
JACKSONVILLE, FL
32258-2558

Practice Phone: 904-268-7701
Practice Fax: 904-268-9708

1306972161 — MRS. ROBIN PAYLOR JOHNSON APRN
Practice Location Address:

14810 OLD SAINT AUGUSTINE RD STE 106
JACKSONVILLE, FL
32258-2558

Practice Phone: 904-268-7701
Practice Fax: 904-390-7478

Directions to “ JERRY ALAN BRIDGHAM MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.