MEDICARE: VICTOR G BRIDGES PAC

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	363AS0400X	Surgical Physician Assistant	014	TN

General Provider Information

NPI Number	:	1760475891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTOR G BRIDGES PAC

Provider Business Mailing Address
First Line	:	939 EMERALD AVE
Second Line	:	SUITE 905
City	:	KNOXVILLE
State	:	TN
Zip	:	37917-4502
Country	:	US
Telephone Number	:	865-647-3350
Fax Number	:	865-647-3359

Provider Business Practice Location Address
First Line	:	939 EMERALD AVE
Second Line	:	SUITE 905
City	:	KNOXVILLE
State	:	TN
Zip	:	37917-4502
Country	:	US
Telephone Number	:	865-647-3350
Fax Number	:	865-647-3359

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	03/24/2014

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Directions to “ VICTOR G BRIDGES PAC” Practice Location

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