Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | MD.208016 | LA |
NPI | 1003129651 |
---|---|
Provider Name | Dr. Jason Peary Bridges |
First Address | Baton Rouge, LA 70808-4366 |
Second Address | Baton Rouge, LA 70808-4366 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2010 |
Last Update Date | 05/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
429019 | (02) | LA |