Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 13776 | MS |
NPI | 1043210024 |
---|---|
Provider Name | Dr. Eric W. Bridges |
First Address | Meridian, MS 39301-4158 |
Second Address | Jackson, MS 39216-4500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00114535 | (05) | MS |
009503980 | MEDICAID OF AL (01) | |
73071276 | BLUE CROSS OF AL (01) | |
E71572 | (02) |