MEDICARE: DR. VANCY HOWARD BRIDGES M.D.

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	207Q00000X	Family Medicine Physician	G7788	TX

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

General Provider Information

NPI Number	:	1982644548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VANCY HOWARD BRIDGES M.D.

Provider Business Mailing Address
First Line	:	1629 BROOK GROVE DR
Second Line	:
City	:	EULESS
State	:	TX
Zip	:	76039-5269
Country	:	US
Telephone Number	:	214-830-1057
Fax Number	:	214-988-2505

Provider Business Practice Location Address
First Line	:	1629 BROOK GROVE DR
Second Line	:
City	:	EULESS
State	:	TX
Zip	:	76039-5269
Country	:	US
Telephone Number	:	214-830-1057
Fax Number	:	214-988-2505

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	07/16/2013

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